Kent Harrison Robbins - South Carillon Beach Condominium Association, Inc. . 650t �1tihs Avg
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139... .
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat or
modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the City
Manager or any city board or committee; or any action, decision or recommendation of any city personnel during the time period of the .
entire decision-making process on such action, decision or recommendation that foreseeably will be heard or reviewed by the city
commission, or a city board or committee. The term specifically includes the principal as well as any employee engaged in lobbying
activities. The term"Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
Robbins Kent Harrison
NAME OF LOBBYIST: (Last) (First) (M.I)
242 Northeast 27th Street Miami Florida 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 532-0500 (305) 531-0150 khr @khrlawoffices.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
South Carillon Beach Condominium Association, Inc.
NAME OF PRINCIPAL/CLIENT:
6799 Collins Avenue Miami Beach, Florida 33432
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 514-7458 hcadizapmanaqement.net
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)]
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: .
Rasi Boaz, President
• IDENTIFY ALL PERSONS HOLDINGii -
II.SPECIFIC IRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: k
LOBBY ISSUE:
Legal Representation of South Carillon Beach Condominium Association, Inc.concerning land use issues related to the application for a
Certificate of Appropriateness(HPB File No.7624)for the property located at 6801 Collins Avenue, Miami Beach, Florida.
Issue to be lobbied(Describe in detail):
Ill.CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4)include the commissioner or personnel sought to be lobbied,and whether the lobbyist has entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's
commencement of service with the city to the present date,stating the general nature of the subject contractual relationship.
Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to be lobbied
Zoning Board of Adjustment None X
Planning Board None X
Design Review Board None X
Land Use Board None X
Planning Staff None X
Mayor None X
Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,familial or professional
relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner or city personnel who is
sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2-482(g)Any Financial, Familial or Professional Relationship
City Agencies/Individuals To Be Lobbied: .
City Manager's Office None X
City Attorney's Office None X
Historic Preservation Board None X
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required)
$595.00/per hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(Required). $595.00/per hour
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Issues":
❑ Yes [X No: Are you lobbying on a present or pending bid for goods,equipment or services,or on a present or pending
award for goods,equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
❑Yes IN No: Are you lobbying on a pending application for a Development Agreement with the City or application for
change of zoning map designation or change to the City's Future Land Use Map?
3) Pursuant to Miami Beach City Code 2-484(h)Any person (except those exempt from the definition of"lobbyist"as set forth in
Section 2-481 above) who only appears as a representative of a not-for-profit corporation or entity without special
compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any
item,shall register with the clerk as required by this section but, shall not be required to pay any registration fees.
❑ Yes N No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement. .
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS C•, PENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT S.ALL ';E FILED EVEN IF THERE •- •VE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIO 9, •
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Alberillik
Sign•'`ure of Lobbyist
I do solemnly swear that all of the fore•'•ing facts are true and correc •d that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach •ty Code --i 9 eporting re3- irem:nts.
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Signature of Lobbyist: ■ ._l_ '
Signature of Principal/Client: IjI,
9 P r VI. LOBBYIST IDENTIFICATI• : PRINCIPAL IdENTIFICATION:
``o�oltiaoiiIi��,,��i
❑ Produced ID v��®� 11E A. ��/i 0 Produced ID
Form of Identification...$. . •• Ma�oy ••"90 . Form of Identification
co��G�22,?�jJ;••"9
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7QPersonally known(Lobbyist) . ® ® � _ ersonally known(Principal)
VII. SIGNATURE AND STAMP OF NOTpas
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State of Florida, County of Miami-Dade ®'�'�o9�PUBCIC SiM ‘■� State of Florida, Cou of Miami-Dade
S •(Id subscrib: ,;-- o e a e - ®'®�aasalaat������� Sworn an• .:- •-• •efo.e m-
— day of G A e'. 016 ..:=s _ - * ,L.:..�� ,'%018
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' 4 1 t 1:i %-_ ::::::17e:0: EMILY GONZALEZ
Slgnat a of ublic Notary—S e of Florida Signature .f P •Iic Notary—S e of FloMY COMMISSION#FF 185568 Notarization of Lobbyists signature Notariza .•n of Princi•al rgnature � EXPIRES: SIGN# 4 2019(AUt orize•%•gent) q,F Bonded E Budget Notary Service
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY OFFLO
Annual Registration fee: [ ]Yes$]No Amount Paid$ ' S0' ° MCR# i11/0 CI l:5 f 5 Date Paid o 3c IC
Lobbyist Registration Form receive and verified by:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 1/11/2011
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,,; . HIV\CA I 1 BEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office CityClerk@miamibeachfl.gov
Tel: 305.673.7411 , Fax:305.673.7254
LOBBYIST NAME: Kent Harrison Robbins
I understand that no later than February 28th of each year, I must file the following
form, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
1) Lobbyist Expenditure and Compensation Form
Failure to file these forms on a timely basis will result in my name being transmitted to the
Miami-Dade County Commission on Ethics and for code violation evaluation.
In addition, once an issue I have registered to lobby on has been resolved, I am required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
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Sig ature: Date:
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