Marissa Amuial - Quadrum Miami Beach, LLC . i
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MIAMI BEA( H s�t � �.t�, 1 Pt 8
City of Miami Beach Office of the City Clerk ,H i')� .�I k; I f G`_
1700 Convention Center Drive, Miami Beach, FL 331 C9
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained,whether paid or not,by a principal who seeks to ncourage the passage,defeat or
modification of any ordinance, resolution, action or decision of any commissioner;any action, deci ion, recommendation of the City
Manager or any city board or committee;or any action,decision or recommendation of any city pers nnel during the time period of the
entire decision-making process on such action, decision or recommendation that foreseeably will a heard or reviewed by the city
commission,or a city board or committee. The term specifically includes the principal as well as a y employee engaged in lobbying
activities. The term"Lobbyists"has specific exclusions. Please refer to Ordinance 2004-3435.
Amulal Marissa R.
NAME OF LOBBYIST: (Last) (First) (M.I)
Akerman,LLP 1 SE 3 Ave Miami FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
Main:305.374.5800 I Fax:305.374:5095 marissa.amuial @akerman.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone,or a-mall address.
I. LOBBYIST RETAINED BY:
QUADRUM MIAMI BEACH,LLC
NAME OF PRINCIPAL/CLIENT:
QUADRUM MIAMI BEACH,LLC 407 LINCOLN ROAD,SUITE 304,MIAMI BEACH,FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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: see ,
• IDENTIFY ALL PERSONS HOLDING.DIRECTLY OR INDIRECTLY.A 5%OR MORE OWNERSHIP INTREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
II.SPECIFIC1OBBY-ISSUE:--___ —
SApprOvals related to the propertylocated at 1825 Collins Avenue,including it ms.related-to.the-hotel,-cabanas;landscapin ,-food-truck.and.other approvals for the
—propeft"y. \-----_
Issue-to-beibbbied(Describe in detail):
III.CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4)include the commissioner or personnel sought to be lobbied,an whether the lobbyist has entered
into any contractual relationship (paid or unpaid)with said city commissioner or personnel from 12 onths preceding such person's
commencement of service with the city to the present date,stating the eneral nature of the subject contrac al relationship.
Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship Explain) YES NO
title of person to be lobbied I
MEMBERS OF PLANNING DEPARTMENT AND PLANNING BOA D NONE I I X
MEMBERS OF HISTORIC PRESERVATION BOARD&NEIGHBORHOOD COMMUNITY AFFAIRS/NONE _ I�-
I x
MEMBERS OF CITY COMMMISSION AND LUDC I NONE I i 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
_NONE
I
F:\CLER\$ALL1aFORMS\LOBBYIST FORMS1Lobbyist Registration Form.doc
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IV. DISCLOSURE OF TERMS AND AMOUNTS crilaYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
CO
A) LOBBYIST DISCLOSURE:(Required)
hou{k1
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): 3 2ct.DO/ I^��`�
(REQUIRED). .J ► 1 �f
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 v_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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes k_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 Section 2-482(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
it m, shall register with the clerk as required by this section but, shall not be required to pay any registration fees.
Yes No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature of Lo byist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Mia Beach C'ty Code and,all ••rting requirements.
Signature of Lobbyist:
NUJ r\. .
Signature of Principal/Client: /�'
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: . °f
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Produced ID .411-.441.s.Al Produced ID ® � N
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Form of Identification .p:.4'=- = Form of Identification g..� i
ersonall known(Lobbyist) �° Personal) known(Principal)Y ( Y ) � � Y ( P ) , a �; w
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VII. SIGNATURE AND STAMP OF NOTARY: a c _ E E
a •o 0
State of Florida, County of Miami-Dade 5. g State of Florida, County of Miami-Dade
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Sworn to and subscribed before me k g Swt.,rn --..subscri before me •```":`.h
This 4� day of e m\ )c)\� oc m g T1 r day of . ,201 ' .A� '
-,---- .,- ., ____--- 18F. A&a■ '40, -
�Signa re of P li r5fay)-St e of Florida @ Signature''`P.bli� otary-State of Florida 1
N izatio' of Lobbyist's signature `` - Notarization o rincipal's signature
TO BE COMPLETED_:Y CITY CLERK'S STA F ONLY C
Annual Registration fee: [ Yes[ ]No Amount Paid$ • MCR# 0 S Date Paid • �7
Lobbyist Registration For eceived and verified by: _,.g ;.a'
F:\CLER\$ALL\iFORM: \L0 YIST FORMS\Lobbyist Amaral Regis--ation Form,doc Revis d 01/22/2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.741 1 , Fax: 305.673.7254
LOBBYIST NAME: Marissa Amuial
I understand that no later than February 28 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, or I am no
longer lobbying on that issue or for that principal, I am required to immediately notify
the City Clerk's Office of lobbyist withdrawal in writing.
Pursuant to Section 2-485 (d), the City Clerk shall notify any lobbyist(or principal) who
fails to timely file a Statement and in addition to any other penalties which may be
imposed as provided in Section 2-485.1, a fine of$50.00 a day shall be assessed for all
Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal)
to file the Statement or pay the assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30th of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade Cou Commission on Ethics and Public Trust.
115
Sighature: Date:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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Camm, Patrick
From: erin.sutherland @akerman.com
Sent: Friday, January 15, 2016 3:27 PM
To: Camm, Patrick
Subject: RE: Lobbyist Registration Forms- Nautilis
Hi Patrick-
Thanks! The Chief officer is Seth Schumer, and no one holds 5%or more ownership.
Erin L.Sutherland
Land Use&Zoning Coordinator
Akerman LLP I One Southeast Third Avenue I Suite 2500 I Miami,FL 33131-1714
Dir:305.755.5853 I Main:305.374.5600 I Fax:305.374.5095
erin.sutherland @akerman.com
From: Camm, Patrick [mailto:PatrickCamm@miamibeachfl.gov]
Sent: Friday, January 15, 2016 2:32 PM
To: Sutherland, Erin (Mia)
Subject: RE: Lobbyist Registration Forms- Nautilis
Good afternoon Erin,
I have received the updated forms and processed the checks. Do you have the Principal Ownership information in
Section 2-482(c) on the first page?
Regards,
Patrick
From: erin.sutherlandOakerman.com [mailto:erin.sutherland@akerman.com]
Sent: Friday,January 15, 2016 11:45 AM
To: Camm, Patrick
Cc: marissa.amuial@iakerman.com
Subject: Lobbyist Registration Forms- Nautilis
Hi Patrick,
Last week I spoke with Jason Salvatore regarding lobbyist registration forms for Marissa Amuial and Nelsen Kasdin.We
needed to swap out the signature page with the originals. Marissa, copied within this email,will be arriving at the City
before 2 pm to swap out those two pages.We've already paid for the lobbyist registration fees.
Thanks!
Erin
Erin L.Sutherland
Land Use&Zoning Coordinator
Akerman LLP I One Southeast Third Avenue I Suite 2500 I Miami,FL 33131-1714
Dir:305.755.5853 I Main:305.374.5600 I Fax:305.374.5095
erin.sutherland @akerman.com
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