Tim Plummer - Fort Partners LLC oa
MIAMIBEACH 3 4- 4.„, 2.
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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
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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.
Plummer Tim
NAME OF LOBBYIST: (Last) (First) (M.I)
David Plummer and Associates, 1750 Ponce de Leon Blvd. Coral Gables, FL
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
glummer @dplummerc-c
(305)447-0900 (305) 305-444-4986 tim. om
TELEPHONE NUMBER: FAX NUMBER: EMAIL: `
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Please notify this office if your contact information changes:address,phone, or a-mail address. -
' tt;
I. LOBBYIST RETAINED BY: —1
Fort Partners LLC
NAME OF PRINCIPAL/CLIENT:
Fort Partners LLC 176 NE 43 Street Miami FL 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) — p
(305) 865-4181
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: Michael Conaghan
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: Nadim Ashi 100%
ii.SPECIFIC LOBBY ISSUE:
;i.La d Uaefand zo'ni g 5sues elated-f oif300'AltoniRola
Issue to be lobbied(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,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
Planning Staff, City Commission, Development None. X
•
Boards, Land Use Development Committee None. X
and Commission as necessary 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 •
NIA
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DIS LOSE WHETHER HOU LY,FL T TE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) U 4I /
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): 7LAD C /'
(REQUIRED). l� �
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 )(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 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.
YesXNo: 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 '• EIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EV 1:I,-. ::' HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD. Apr
Signature of Lobbyist R. ,
I do solemnly swear that all of the for-.•'-. is a =tru-and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami B--c Ci .C ,'- and .,I r?•orting requirements.
Signature of Lobbyist:
r.
Signature of Principal/Client: Ste, AAA..
l `P Dct.(2.. r--)VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: -,C
j -
_Produced ID —
Produced ID ,�
Form of Identification Form of Identification
..� -
Personally known(Lobbyist) _Personally known(Principal) . �=
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VII. SIGNATURE AND STAMP c sinTAtw•
T\
"''M'"" s ROSARIO R BERWIDES - =
State of Florida, County oaf Miami-Da.� �,∎ . M1'COMMISSION#FFg23240 State of Florida,County of Miami-Dade
Swor r• nd,subscr,i.e,)b:fo - r e �` EXPIRES:November 21,2019 Sworn and subscribed before me
VJJ - sue-.
Thisr . i*_,. da .1 rr>W, , Sa odThm►btifyPubicUdwn'e, This day of ,201
Iwri
Signat re of Public Notary-State of Florida Signature of Public Notary-State of Florida
Notariz• '. of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S ST•, F ONLY
Annual Registration fee: ro Yes[ )No Amount Paid$`41,V, CI0 MCR U 7. Date Paid Ob-70-i4
Lobbyist Registration Form received and verified by: _,Iii. OrJ VI,' a' • _
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
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST NS-TION(DIS LOSE WHETHER HO L� T T TE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) `1,0 /
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): ?a C J11�/ !(
(REQUIRED).
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 iobbYInq on.a present or pending bid for goods,equipment or servlces_,.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 appiicatlon'for.a Development Agreement with the City or application for
change of.zoning map designation or change to the Cltv'S.Future(and.Use.Map?
3) Pursuant to Miami Beach City Code Section 2-482(h)Any person(except those exempt front 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 tut,shall not be required to pay any registration fees.
YesXNo: Are you napresenting a not-for-profit corporation or entity without speclal.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. UST1NO LOBBYING:EXPENDITURES.AS LL
. E AS'COMFENSATION. i EIV8O (b!: .CITY OF MIAMI.BEACH FOR
THE PRECEDING CALENDAR YEAR A STATEMENT SHALL BE FILED• /=+•, HAVE.BEEN NO EXPENDITURE.OR
COMPENSATION DURING THE REPORTING PERIOD. • --
y.
Signature of Lob yist BO_
I do solemnly swear that all of the for la .`: s a.=tru and correct and that I h=ve read or am familiar-with the provisions contained
In Section 2-482 of the Miami B CI..0 r:a d JI ...orting requirements.
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Signature of Lobbyist: �. `ice
Signature of Principal/Client: A,ar
VI. LOBBYIST IDENTIFICATION: I PRINCIPAL IDENTIFICATION:
_Produced ID —Produced ID
Form of identification Form of identification
Personally known(Lobbyist) A rsonally known(Princlpa$•,.!•4€, VANESSAVIRGWO
* . * MY COMMISSION#FF 022448
VII. SIGNATURE AND M TA Da di '' EXPIRES:May 29,2017
1 e ,'',rib P8 t 43,, f�oo-°! Boded Thru Budget Notary Services
State of Flo da,Cou i ty o MYCOMMi3SION OFF@23240 State of Florida,County of Miami Dade
Sworn '. subsc{'e"'b='o = e .I . ,1 EXPIRES November21,2019 ` Sworn and subscrl0�: before me I -
This,i, da •i Mohr , .•.,::40=-' Bonded ThrorloberyPubrolh ram: This -L( day of ■, LI , •01-1-
IA.Ir II Vill■M . r-, IP: ,, At.
Signet re o Public Notary–Sta a of Florida. S gna : of Public No ary–S :te'of •rida
Notariz: ign of Lobbyist's signature otariza on of Principal's signature
• TO BE COMPLETED BY CITY CLEFS^,rIFF ONLY
Annual RegIstratlon fee: [ .)Yes( 3 No Amount:Pald$ OCR#- .Date Paid:T
Lobbylst.Registratlon Form received and verlfied.by:
P:\CLER1$ALLNeFORPiS\LOBBYIST r!ORMS\I.obbylst Annual rtegls0ra004 Forni:d'oc . : . . Revised O1Ja2i20 4. ••
. F:\CLERI$ALLIaFORMS\LOBBYIST FORMSILobbylst Registration Form.doc
MIAMI BEACH •,
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florido 33139,www.miamibeachN.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fox: 305.673.7254
LOBBYIST NAME: Tim Plummer
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 EXPENDOTURE 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 IUAiami-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 ded from lobbying until all fines are paid, unless the fine has been
appealed to the,r4M7 r',_ tt, -Fie County Commission on Ethics and Public Trust.
410/ a�Si natu : �' e:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
MIAMI BEACH
City of Miami Beach
2016 f=1 E i Y 27 PR 12: 0 9
1700 Convention Center Drive ,' i;l__.;,; ,' OFFICE
Miami Beach, Florida 33139
www.miamibeachfl.gov
City Clerk's Office
Tel: 305-673-7411
Fax: 305-673-7254 Office Use Only
ANNUAL LOBBYIST REGISTRATION FORM
Name: Tim Plummer
Business Name: David Plummer and Associates
Address: 1750 Ponce de Leon Blvd., Coral Gables, Florida
Office Telephone Number: 305-447-0900
Cellular Telephone Number:
Email Address: tim.plummer a(�dplummer.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.
For City Clerk's Office Use Only
MCR#: 077
Amount paid: _ 5cc CI Date paid: 0 6 - 30 - I '6
Processed by: °- N CAZ1Jg'i-at- Date: 06- 30- /6
F1CLER\SALLWFORMSILOBBYIST FORMSWNNUAL LOBBYIST REGISTRATION FORM reg-tlocx
City of Miami Be.3ch c, ,
City Hall L .
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1700 Convention Center Dr. ` N c 0 1
Miami Beach , FL 33139
305-673-7420
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