Wayne M. Pathman - Monterey M I AM I BEAC Office of the City Clerk
1700 Convention Center Drive r r-
Miami Beach, FL 33139 -
305.673.7411 2016 SE _.9 R+, 3: C )
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage_the,pasage,Vd'efeat 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 City Code Chapter 2, Article VII, Division 3, entitled "Lobbyists,"
for additional information.
Instructions: Please complete all sections of this form and submit the completed form,with the applicable fee,to the Office of the City
Clerk. If you need more space to complete an answer, use a separate sheet(s) of paper. If you have nothing to report in a particular
section, you must write "none" or "n/a" in that section. Any change to any information originally filed, or any additional City
Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amendment to the registration form.
The lobbyist has a continuing duty to supply information and amend the forms filed throughout the period that the lobbying occurs.
Separate registration forms shall be required for each principal represented on each specific issue.
I. LOBBYIST INFORMATION: i
?4-44 Mt^ IN)1n M e- /' -
NAME OF LOBBYIST (Last) (First (Middle Name)
PcAma„,.. Lewis LA.?r a S. 12)15 I4 2L(oo / , Ft./ 3313 1
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street City) (State) ' (Zip Code)
(2)0 — 3/ 9- 2z12_c - - 33c -005 1/0PaAt alAaiAigsi PcL,T(.t nyut La015,(0.G'�
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION: 11
�?n-€ (; /1 C rte. /T7Z 0
NAME OF PRINCIPAL (La t) (First) (Middle N e)
P r</ �2� � M/(-444/6 &IL 3'3(3
PRINCIPAL BUSINESS NAMEIAND ADDRESS (Number and Street) (City) (State) (Zip Code) .
•
7' - 2 c (� V t ✓I c 2 rtT C T"I^e C OSM O 6-114.C o NV
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided pursuant to City Code
Section 2-482(c):
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
• NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
III. ISSUE TO BE LOBBIED:
Describe with as much detail as is practical, including but not limited to a specific description where applicable of a pending request for
proposal, invitation to bid,or public hearing number.
M�� z o � s / H__(_Vt-G11 r, /4t). 3 ode- 13 `-
Die
IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4), list the City Commissioner or City personnel sought to be lobbied, and whether the
lobbyist has entered into any contractual relationship(paid or unpaid)with said City Commissioner or City personnel from 12
months preceding such commencement of service with the City to the present date, stating the general nature of the subject
contractual relationship.
Full Name of Individual and Contractual Relationship(If yes,explain) YES NO
Title of Person to be Lobbied
ComMrss"vim- S-i-
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.
List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an appearance of
impropriety:
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note that a
contingency fee is prohibited pursuant to City Code Sec. 2-485.3):
i. 50° / he
The following five(5)questions MUST be answered:
1) Pursuant to 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 City Code Section 2-490, entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development
Issues":
_Yes /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 City Code Section 2-482(h), any person (except those exempt from the definition of "lobbyist" as set forth in
Section 2-481)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 city clerk as required by this section, but shall not be required to pay any registration fees.
_Yes 4o: Are you representing a not-for-profit corporation or entity without special compensation or
reimbursement?
4) Pursuant to City Code Section 2-481, the term "lobbyist" specifically excludes the following persons: Expert witnesses who
provide only scientific,technical or other specialized information or testimony in public meetings; any person who only appears
as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether direct,
indirect or contingent,to express support of or opposition to any item; and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or
reimbursement for the appearance.
Yes 41o: Are you providing only scientific, technical or other specialized information; appearing as a
representative of a neighborhood association without special compensation or reimbursement or
representing a not-for-profit based organization for the purpose of requesting a grant without
special compensation or reimbursement?
5) Pursuant to City Code Section 2-482(a)(4), a lobbyist who has within the past election cycle provided campaign consulting
services to an incumbent member of the City Commission shall disclose such particular service on his/her lobbyist registration
form and shall orally disclose such particular service before lobbvinq the City Commission at a public meeting.
_Yes/No: Have you provided campaign consulting services to an incumbent member of the City Commission
within the past election cycle?If yes.please list the incumbent member(s)of the City Commission:
If yes, you must also orally disclose such particular service before lobbying the City Commission at a public meeting.
VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENSATION DURING THE REPORTING PERIOD.1
Signature of Lobbyist: 40'et Date
f
I do solemnly swear or affirm tha• all of the foregoing facts, statements, and disclosures in this form are true and correct,
and that I have read or am familiar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
the Miami Beach City Code and all reporting requirem-nts.
Signature of Lobbyist: _ �r��� Date
Signature of Principal: Date
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: )/, PRINCIPAL
State of 1!-t iLt O Pc State of
County of: M I A M I - i)11-1-)1•::- County of:
Sworn to (or affirmed)and subscribed before me Sworn to (or affirmed) and subscribed before me
this 1 day of 5e-1171- , 2016, by this_day of ,2016, by
OttlA,e m
NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced ID _Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
lIersonally Known _Personally Known
Signature of Notary Pub li J Signature of Notary Public
Dorinda Triponey
Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped
• ',,,,
" P` DORINDA TRIPONEY
"Y F NOTARY SEAL)
SEAL)!_,',�, MY COMMISSION#FF 224382 ( )
EXPIRES:July 10,2019
v a'''` Bonded Thw Notary Pi.hie:Underwriters
BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[yi No Amount Paid$ 3So•co MCR# '(II tt S l Date Paid 0d1-0t-/o
Lobbyist Registration Form received and verified by: oesoN $.q-c-vA 011.6
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 08-18-16 REG.doc Revised 08/18/2016
1 The term"lobbyist"specifically excludes the following persons:
Expert witnesses who provide only scientific,technical or other specialized information or testimony in public meetings; any person who
only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance, whether
direct, indirect or contingent, to express support of or opposition to any item; and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for
the appearance.
VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNED STATEMENT UNDER OATHi LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATION
RECEIVED. FQR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
P NDITUR_ • - COMPENSATION DU-IN THE REPORTING PERIOD.=
;1;pnature of Lobbyist: Date
do solemnly swear or affirm that all of the foregoing facts, statements, and disclosures in this form are true and correct.
aid that I have read or am familiar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" ;,f
I.i
e Miami Beach City Code and all reporting requirements.
ictrtature of Lobbyist: - Date
,t
Signature of Principal:; _ / l/ Date g/6, 14
VII. ROTARY SIGNATURE AND SEAL:
LOBBYIST: '1 PRINCIPAL
ti ate of 1-e IZ l p A !\-State of r I � r
.arty of: CI @I .Mt teA'0 County of: `)t-_ .,
4.vorn to (or affirmed)and subscribed before me Sworn to(or affirmed) and subscribed before me
th:s day of . 2016, by this—day of . 2016, ay
-6-41/ eCIVACk 0)kIC.424/1/4 NAME OF LOBBYIST NAME OF PRINCIPAL ���
__-_Produced ID _Produced ID ✓✓
FORM OF IDENTIFICATION FORM OF IDENTIF TION
_.,Oersonally Known 2i0ersonally • n
i
Signature of Notary Public Signature of Notary Pu c
C2rsh IA-e I n
Name of Notary,Typed, Printed or Stamped Name of Notary, Typed, Prin :d mpisly Public state of Florida
Cristiane C Leon
(NOTARY SEAL) (NOTARY SEAL) T My Commission FF 243052
p Expires 08/0412019
_ TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
&'mum :2egistration fee: [ J Yes[ ]No Amount Paid$ MCR#_ Date Paid
L.ttbbyist Registration Form received and verified by:
• $ALL\afORMS\LOBBYIST FORMS Lobbyist Registration Form Revised 08-18-16 REG.doc Revised 08/18/2016
The term"lobbyist"specifically excludes the following persons:
-xpert witnesses who provide only scientific,technical or other specialized information or testimony in public meetings; any person who
cnly appears as a representative of a neighborhood association without compensation or reimbursement for the appearance, whether
ctrect, indirect or contingent,to express support of or opposition to any item; and any person who only appears as a representative of
rot-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for
the appearance.
•
MAM1 BEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
Office of the City Clerk
Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.741 1, Fax: 305.673.7254
/� i
NAME OF LOBBYIST:
1,3o-„1.?_ M . I'd-etzitri ,
1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT
Pursuant to City Code Section 2-485(d), the City Clerk shall notify any lobbyist (or
principal) who fails to file timely a Lobbyist Fee Expenditure and Compensation Statement
(Statement). In addition to any other penalties that may be imposed as provided in
Section 2-485.1, a fine of $50.00 a day shall be assessed for Statements 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 County Commission on Ethics and Public Trust.
I hereby acknowledge that on February 28 of each year, I shall submit to the City Clerk a
signed Statement under oath listing all lobbyist expenditures, as well as compensation
received, for the preceding calendar year with regard to the specific issue on which I have
been engaged to lobby.
2) LOBBYIST WITHDRAWAL
Once an issue I have registered to lobby has concluded or I am no longer lobbying on
that issue, I shall immediately file a Notice of Withdrawal with the Office of the City Clerk.
3) ANNUAL LOBBYIST REGISTRATION FEE
I understand annual registration of all lobbyists shall be required for each 12-month period
commencing October 1 of each year, and the fee for such annual registration shall be
$500.00 pursuant to Section 2-482 of the Miami Beach City Code.
/V)
Signature of Lo• • Date
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 08-18-16 REG.doc
Salvatore, Jason
From: Dorinda Triponey <dtriponey @pathmanlewis.com>
Sent: Thursday, September 08, 2016 9:23 AM
To: Salvatore, Jason
Cc: Granado, Rafael
Subject: RE: Lobbyist Registration Forms being mailed today - Monterrey Condo/Vince Langone
It's already gone out in the mail, can you just write in $500/hr for me please? My apologies for the oversight,still
getting used to the form.
Many thanks!
Dorinda
PATHMAN LEWIS, LLP
ATTORNEYS AT LAW
Dorinda Triponey
Legal Administrative Assistant to Wayne M. Pathman, Esq.
Legal Administrative Assistant to Richard N. Schermer, Esq.
Pathman Lewis, LLP
One Biscayne Tower, Suite 2400
Two South Biscayne Boulevard
Miami, Florida 33131
Direct: 786-437-7456
Main: 305-379-2425
Fax: 305-379-2420
Email: dtriponey c(�pathmanlewis.com
Firm Website: www.pathmanlewis.com
ROLL TIDE!
This message and all attachments are a private communication sent by a law firm and may be confidential or protected by
privilege. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or use of
the information contained in or attached to this message is strictly prohibited. Please notify the sender of the delivery
error by replying to this message, and then delete it from your system.
From: Salvatore, Jason [mailto:JasonSalvatore @miamibeachfl.gov]
Sent: Thursday, September 8, 2016 9:17 AM
To: Dorinda Triponey
Subject: RE: Lobbyist Registration Forms being mailed today- Monterrey Condo/Vince Langone
Good morning Ms.Triponey,
1
Please ensure Section V- "DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION" is completed. This is a
required disclosure.
Thank you,
MIAMI BEACH
Jason Salvatore - Office Associate Ill
Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Tel: 305-673-7411 www.miamibeachfl.gov
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical,
historic community.
From: Granado, Rafael
Sent: Wednesday, September 07, 2016 7:07 PM
To: Salvatore, Jason
Cc: Granado, Rafael
Subject: FW: Lobbyist Registration Forms being mailed today - Monterrey Condo/Vince Langone
Good afternoon Jason,
See below.
Acknoweldge receipt upon receiving the original in the mail.
Regards,
MJAM BEACH
Rafael E. Granado, Esq., City Clerk
OFFICE OF THE CITY CLERK
1700 Convention Center Drive, Miami Beach, FL 33139
Tel: 305-673-7411 rafaelgranado(cr�miamibeachfl.gov
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical,
historic community.
From: Dorinda Triponey [mailto:dtriooney @pathmanlewis.com]
Sent: Wednesday, September 07, 2016 3:09 PM
To: Granado, Rafael
Cc: Dorinda Triponey
Subject: Lobbyist Registration Forms being mailed today - Monterrey Condo/Vince Langone
Good afternoon, Rafael: please see the attached form that is being mailed to your office today.
Thank you.
Dorinda
2
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