Loading...
Martinelli Tomas - Kevin Heneghan MIAMIBEACH ,,,: n City of Miq mi Beach Office of the City Clerk 1700 Conventioh Center Drive, Miami Beach, FL 33139 2616 AUG H2 Phi I. 05 • LOBBYIST REGISTRATION FORM "I i '( i;j 01--f• j fir_ 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. Martinelli Tomas NAME OF LOBBYIST: (Last) (First) . (M.I) 888 Brannan Street San Francisco, CA 94103 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 415-662-3254 tom.martinelli@airbnb.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: Kevin Heneghan NAME OF PRINCIPAUCLIENT:Airbnb, Inc. 888 Brannan St. San Francisco, CA 94103 • BUSINESS NAME AND ADDRESS Number and Street) (City) (State) (Zip Code) 415-662-3254 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:Brian Chesky, Nathan Blecharczak, Joe Gebbia, and Sequoia Capital • IDENTIFY ALL PERSONS HIO4DING,DI U;O' INDIRECTLY,A 5%OR Ms RE OW ERSHIP INTERS TIN SU H CORPO'•TIgN, • �j PARTNERSHIP OR TRUST:0r\Ah �Q ► _ ti. i e ' t0 •, wJ "!P II.SPECIFIC LOBBY ISSUE: rm rent S 1odd- �1 a` S hr=te al rgation Issue to be lobbied(Describe in detail): 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 City of Miami Beach 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 It‘j O-NE F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc Al_11■ • • IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) F , /I - , ' t 17, tOL.?O PL-e--"- 1-pA..04.1. B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): "`---i��� 1 I (REQUIRED). b \b O 0 r 1pA°''t 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 XNo: 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 XNo: 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 item, shall register with the clerk as required by this section but, shall not be required to pay any registration fees. Yes XNo: 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 • BMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS CO. PEN TI N CEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHAL :E FIL E E F THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. I . ,r , Si., atur of Lobbyi • I do solemnly swear that all the fore oing�.:cts :re true a . .-: ect and that I have read or am familiar with the provisions contained in Section 2-482 of the Mi i Beach y C.(.e a, • all reporting requirements. Signature of Lobbyist: i Signature of Principal/ lie t: 1 • VI. LOBBYIST IDENTIFICATION:ATION: PRINCIPAL IDENTIFICATION: c I 1 • X Produced ID Produced ID dritjej'j /ice. Form of Identification Form of Identification _Personally known(Lobbyist) —Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade State of Florida, County of Miami-D.•- Sworn to nd subscrjail d fore me Sworn and subscribed before - T'is .O4 •. of , 201 .. This day of , 201_ :�.:G MIREYACARBALLOSA / '•'' MY COMMISSION#FF 170941 Q •�I _ v�� `� ,/ /__ -./_ s'•..1 W. EXPIRES:February 22,2019 Se Axe gnatu4- of P•: ' otary–State of Flo d.. ' BondedThruNotaryPublieUnderwrur t;., Lure of P . 'c Notary–State of Florida otari.6 tion of Lobbyist's signature I�!arizat'• of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: es[ ]No Amount P id 1 W MCR# t t> q 0 Date Paid Lobbyist Registration Form received and verified by: Lillian 4.4 utL4 i F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 0 /22/2014 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE §8202 C��t��t!si��<_atr't!�it��t!c��t�J:�N.:�_at�t!�iN_s����t��t!�i�.at/-�{��t�alca•_aN.aNc�i•_at_a.at_at_at� See Attached Document (Notary to cross out lines 1-6 below) ❑ See Statement Below (Lines 1-6 to be completed only by document signer[s], not Nota 1 2 3 5 6 Signature of Document Signer No. 1 Signature of Document Signer No. 2 (if any) A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California -� Subscribed and sworn to (or affirmed) before me County of Saul Tfat�C15CV on this 25..t day of -LIZ , 2016 , by Date rlt4onth Year (1) Keel u a ' -�► JEREMIAH EDWARD-DAVIS (and (2) ), ::'Itt, Notary Public-California Name(s) of Signer(s) ' ?■ San Francisco County Vr-r,/ Commission sr 2153470 - proved to me on the basis of satisfactory evidence M Comm.E 17.2020 to be the person(s) who appeared before me. Signature 1 GAOL- di'4e- / Signature of Notary Public Seal Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: L�L�'�<�L�L�L�L�L�LV L�L�L�L�L�e{.'a.G'✓L�L��:L�.'eii,�U,L�1r�ti Lri0.d+�4�.riLCa:�eiL�d,.'!/L�d4'c/L�L�.'tiL-LL��L�t!L��!.ri.�:��1.L��!L_ ©2014 National Notary Association • www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5910 MIAMI BEACH 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: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: %mas 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 automati• Ily suspended from lobbying until all fines are paid, unless the fine has been • apps • to the i I-' .de County Commission on Ethics and Public Trust. A.. . - - 7 I P1-9-4e4.S�:ture: Da • • • • F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc Miscellaneous.Cash Receipt r;ITY 3F MIAMI BEACH No ❑ Cash 0 Credit Card t-TC ck# 1 3(IVV'1 , �:3 '. . l . : 20 City of MiarReceiaed of I h r''1 `i j H art, ;-/C 1 i MiscellaneotAa 62016 3 _6 'J( r 1 .1 m .1 1!I a ( , , t--, r, r ■ : r "I.; 7 000372-0011 Maria B... 08/02/2016 01:02PM •MCR OPENFOr ,, _.,.,,..,...1 s , M i.r' 2.g.;i ;(4 n c> .--`}+ 1 r 1:'l h \_c't_- Payment Amount: , 850.00 MCR410790 (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director :s Account Number ;.. ' 1 •lam ,'.` ji?'1 k-I'4 -:)- 30'i_ 3 �- ""--)7 L"\--:_ .'1) 't `_1 1 - Preparer: Yl r.:,+� '. r,�.: .' �< l_ -., Dept: '. .s� /• •• Err: 1 T I r •i / 1y a O O O O c0 , Ca W Li, in O e ti f a) t 2`) N i 1 - I.1 . CO.— Q� J N \ — = . it .':, •' › l U 127 3 c. Q UIZ CI a) co Q) Lt) Z U 1 S_ .:7-1- R ■ VJ 4) N ++ t0 Y Ql _ = C S U 2� 3