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Mike Antheil - Renovate America, Inc.
P� `e(en • MIAMI BEACH , . City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 20 16 ,EUI 22 ,,r1'; I I: PO 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. Antheil Mike NAME OF LOBBYIST: (Last) (First) (M.I) Renovate America, Inc. do 2350 Kerner Blvd.,Ste.250 San Rafael CA 94901 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (415) 389-6800 (415) 388-6874 renovateamerica @nmgovlaw.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: Renovate America,Inc. NAME OF PRINCIPAL/CLIENT: Renovate America,Inc. c/o 2350 Kerner Blvd., Ste.250 San Rafael CA 94901 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (415) 389-6800 (415) 388-6874 renovateamerica @nmgovlaw.com 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: J.P McNeill • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: N/A II.SPECIFIC LOBBY ISSUE: Matters pertairifng:to-energy an d,waterg ciency financm� Issue to be lobbied(Describe 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,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 All commissioners and personnel N/A 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 NIA F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc • IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $400.00 hourly B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). $400.00 hourly 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": _Yesslo: 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"lo: 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. _Yeslo: 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 Lobbyist 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 Miami Beach City Code and all reporting re.uir- - ts. Signature of Lobbyist: X Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID I OR%tJiA' _Produced ID Form of Identification � Form of Identification • 1311c 4' Personally known(Lobbyist) ' ld■ Personally known(Principal) r SNip O - VII. SIGNATURE AND STAMP OF NOTARY: m c State of Florida, County of Miefwi-Dadee -11 State offfenider, County e#-MiemrDadg : ��rn to and--$$ubscribed before me �' Sworn and subscribed before me . Thi./ t'1V . : _ An= ,201 it Cr) 8 This day of ,201_ I '.�; �•'y � I GCS— D ��• -ture of Public Notary— tate of Florida Signature of Public Notary—State o • • Notarization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[1)11]No Amount Paid$ '330•U MCR# ]e' 7Vo`Z Date Paid 196'1,67—11/ Lobbyist Registration Form receive and verified by: P)' SJ*tAj " L F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 01/22/2014 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc CALIFORNIA JURAT WITH AFFIANT STATEMENT GOVERNMENT CODE§8202 arz -p,,-1?w._w .w-.w v.•.w•.w•.aER.•ia .a-.w•.we.w..s�• ER•.w•.w C.w •.wt�.r . R •�f.-� . .- 0See 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 Notary) 1 L 3 4 5 . 6 SI - _ . c • 1• u-• '••- ■ • ' -• 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 before me County of Mac:n on this 62\ day of -S051. - _, 20 (b by Date Month Year (1) --Seccc\e, l) c rc c�keH-oV (dlld (2.) TYLER WILLIAM KLEINMAN • Name,*of Signeffst „,140r:',?!...., Commission #2137003 z �� `! Notary Public-California i proved to me on the basis of satisfactory evidence 9I Marin County s• to be the person(- who appeared before me. _. My Comm. Expires Dec 15.2019 Signature (l . 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(e)Other Than Named Above: L:�,:�✓wti'd0:Si, :A:.:�6`✓.G,%%✓,, .'.%G\✓:-LheSiS..Y<%LLL.:S✓:�4�K✓.S✓:C✓:� ✓:S✓i✓%✓`✓%,✓:4✓i\✓C.✓..�%iSL•fW✓ti✓V,,,,,WY,iS✓i�✓1'!C.S.1:. ©2014 National Notary Association •www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item #5910 MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov CITY CLERK Office Rafael E. Granado, City Clerk CiyClerk @miamibeachfl.gov Tel:305.673.741 1 , Fax: 305.673.7254 LOBBYIST NAME: Mike Antheil 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-Da County Commission on Ethics and Public Trust. Sig Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc tv"\ AM I BEACH City of Miami Beach 2016 ,!�i': 22 all 1 1: 1700 Convention Center Drive Miami Beach, Florida 33139 C I.i i. www.miamibeachfl.gov City Clerk's Office Tel: 305-673-7411 Fax: 305-673-7254 Office Use Only ANNUAL LOBBYIST REGISTRATION FORM Name: Mike Antheil Business Name: Renovate America, Inc. Address: c/o 2350 Kerner Blvd., Ste. 250 Office Telephone Number: (415) 389-6800 Cellular Telephone Number: (877) 747-4889 Email Address: renovateamerica @nmgovlaw.com If more than one lobbyist, please list: 1) 2) 3) 4) 5) 6) 7) Submit this form to the Office of the City Clerk, along with a check for $500 for each • lobbyist. Please make the check(s) payable to the City of Miami Beach. j I For City Clerk's Office Use Only MCR #: F 10 7 0 3 Amount paid: 5 0 0 • b() Date paid: O b - c 2- I b Processed by: —14600 C .A-115AG Date: 0 6 - I 6 F.\CLER\$ALL\aFORMS\LOBBYIST FORMS\ANNUAL LOBBYIST REGISTRATION FORM reg.docx Miscellaneous Cash Receipt a CITY OF MIAMI BEACH 41 0703 No. 0 ❑ Cash ❑Credit Card 4,Chedk# 7 $ S carte , c), City of MianeQsi@yKed of 11� OC7-at a 20 �� d�re"ss� 3 Sc,' IC-enN�P--. 000219-0053 Jenel F. 06/22/2016 11:37AM +7 �v� 5-�`c d 5o, 5,��,j F1� EL , t=/y ti r MC,R OPENFor I 4NiN\An 1_ K E &.i i(il ft-7-i s i Payment Amount: 500.00 MCI3410703 (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director By Account Number: 0) / ' 000 0 - - ci L/94- 00 - 30 - 3 6 S- 00- (X)- (:) ,, Preparers ---)P-5'0A) k l.vi+ } !Z 6 Dept: C_' E) 7L/ l j CD c7 a C� 0, - = z f-1 c II z ! Cr CO - —C f o - o ND r°+ 3 co . J - cn °� OCD r `1 i = z O v 0 D O a 9 ii r z0 _. 0 c� = 00 CV sI — m o 3 cCn c - ' I S 1' z ° c) c C.J = 'c pp F 3 V __ o ~' ti n'1 W ? { CO T7 CIDD = O 0 V O O C-) -D.`G 3 C7 0 i i 3 W 1 = 207 _ w B -< Q` ii NJ LI x0-4- f0 lD D -All i 1 �I' O O O Lr: O O O O O 0 O w 0 C. O - 0 �O y, O 3 0 O O O C • Miscellaneous Cash Receipt CITY OF MIAMI BEACH No: 4 07 02 '0 . 0 Cash 0 Credit Card .Check# $ ,: City of Miang9WWed Of / MG-C 14- °'1-We-It, ,,_ -- ►d ess2GEZn5o 1 6.. 1 1..(,.2. i')t, S- 2 , S1 t,, . , � , - 000219-0052 Jenel 0612 /2016.11:35AM MCR OPENFor i !S>'Ll Payment Amount: 350.00 MCR410702 (THIS.INFORMATION MUST BE COMPLETED) - __ _ Office_of Finance Director By 44 Account Number: 01I-000c?- (0`1, LILjLi - pU- SO-7- 3(,C- o0- ob- C� _ as f: - : '.Preparers °JJ•A 7f Llrf (L� Dept: C EXT: `) I I T c� - c a o y n, _ a�i ; SC7 �� 3 �f C) (�CCD N o co B CD m .+ Ill I iZ -- - o c,a O1 o m � `° , i -o =3 n it pp i CCD 0 o o• n o t--I a m z o _.o _ s i z oC = O m o 7 c€ m CU C) o 2 z Co c) cu g COriCCDD CD 0 `C i D O - Cj S C•`< 3 N O D O T 0 v` = J a �:4�. 5 �. •' r CD `C a 3 2.. N � CD d CAD - $I N r...)O i 1.0 O 4f 1 on a i I CJ CJ 47 C.) O i o 0 0 0 : o -• a O i o b O ' o v C) i O OC O , O 3 O •