Carter N. McDowell - RP Hotel Holdings, LLC /skis c.H,4-73
MIAMI :- . -
Office of the City Clerk
1700 Convention Center Drive
Miami Beach, FL 33139 2II17 E;I'! ° `i 5
305.673.7411 ;:•�
LOBBYIST REGISTRATION FORM ;! L ; • , ,, : L
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 City Code Chapter 2, Article VII, Division 3, entitled "Lobbyists,"
for additional information.
Jnstructions; 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:
McDowell Carter N.
NAME OF LOBBYIST (Last) (First) (Middle Name)
Bilzin Sumberg Baena Price&Axelrod LLP-1450 Brickell Avenue, 23rd Floor, Miami, FL 33131
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-350-2355 cmcdowell @bilzin.com
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
NAME OF PRINCIPAL (Last) (First) (Middle Name)
RP Hotel Holdings, LLC
1545 Collins Avenue Miami Beach FL 33139
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
786-276-0303 pradeep.bobba @royalpalmsouthbeach.com
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: D. Rick Adams(Vice President)
• NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: Publicly NYSE Traded REIT
•
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.
Code Enforcement matters regarding 1545 Collins Avenue, Miami Beach, FL
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
City of Miami Beach Code Enforcement/Staff x
City of Miami Beach Special Master/Staff 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.
List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an appearance of
impropriety:
none
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):
hr
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 X No: Are you lobbvina on a present or aendina bid for aoods.eauipment or services. or on a present or
pendina award for goods.eauioment or service?
2) Pursuant to City Code Section 2-490, entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development
Issues":
_ Yes X No: Are you lobbvina on a cendina application for a Development Aareement with the City or
application for chanae of zonina map desianation or chanae to the Citv's Future Land Use Mao?
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 x No: Are you reoresentina 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 X No: Are you orovidina only scientific. technical or other specialized information: appearing ag
a representative of a neiahborhood association without special compensation or reimbursement or
reoresentina a not-for-profit based oraanization for the ouamse of reauestina a arant wltki d
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 lobbying the City Commission at a public meeting.
—Yes_X No: Have you provided campaian consultina services to an incumbent member of the City Commission
within the past election cycle?If yes,please list the incumbent meniber(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}�OBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENSATION RING H• R P RTING PERIOD'-
Signature of Lobbyist: �`L/�,i� Date / ,v/7
Carter N. McDowell
I do solemnly swear or affirm that 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 reporttiig requirem-n -? „,
,r.` ' /
Signature of Lobbyist: ` _ / Date �//4,r ,15 7
Signature of Principal: der-
,
Date / /Z('/ 7
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of Florida State of Virginia
County of: Miami-Dade County of: Fairfax
Sworn (or affir )and subscribed before m-my Swofrito(or affirriled)and subscribed before e
this f ? 20 tar • this `t day of J 4nv . 201�by
--, _•fir 10. 11 U Le-L .0_ D t 1./c Mara
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NAME OF LOBBYSLJ NAME OF PRINCIPAL
_Produced ID _Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
_`�Pers na o n
i .a Personally Known
OF ,,, 1lrrrr;i,�
^— ..'... L.:�_./L4 �. % _ LM•;,., /iii
Signature o tart'Public �S Signature of Notary • blic vc,•..MoniivF•.•9''�
(13 Name of Notary, Typed, Printed or Stamped Name of Notary,Typed, Prim. ' wlg9� I.1? *
(NOTARY Ep44), IBIS C
� . ,, � (NOTARY SEAL)
11A..k �'�RG�ta;P'�� .�
MY COMMISSION Y FF 111262 i )` `. �∎
;np,:. EXPIRES:May 24,2018 .it RY PV�N�N
'P,4; ornf/ Bonded firu Budget Notagk§eg OMPLETED BY CITY CLERK'S STAFF ONLY • 111/11IIt0�
Annual Registration tee: [ ]Yes[VI No Amount Paid$ ISO ill' MCR# `{ii(71. Date Paid Of-0 i•//
Lobbyist Registration Form received and verified by: J 1t'Sf,;U S4-L.LA-Gaa j
F:ICLER\$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.
t
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 B FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENSATION DURING THE REPORTING PERIOD,-
Signature of Lobbyist: Date
Carter N. McDowell
I do solemnly swear or affirm that 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 requirements.
Signature of Lobbyist: Date
Signature of Principal: 00,7- Date / y/2a/7
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of Florida State of Virginia
County of: Miami-Dade County of: Fairfax
Sworn to(or affirmed)and subscribed before me Sworrfto(or affirry�ed)and subscribed before e
this day of ,2016, by this `t day of J 4r14) ,201Tby
1) ..t uc- n1
1
NAME OF LOBBYIST NAME O PRINCIPAL
_Produced ID Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
_Personally Known 16 Personally Known
/ / Ittt►,,o,�
b. . --Jl .� % _ LM•; , '0i,
Signature of Notary Public ignature of Notary • blic r,�f...!:,5,;;i,•..,,.1710,
� ! k"J 4 SI; -9y
I '.A .' ✓rI1 CA .. ..1.- _ S N
Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Pri ' - ::,.,7 * :.
(NOTARY SEAL) (NOTARY SEAL)
S.IA, L',RG%' "`V. •
• "AYPVC0
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY ��I11111I110.
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid
Lobbyist Registration Form received and verified by:
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.
•
IV I/A lk ra LAC H
; ,; ,
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: 305.673.7411, Fax: 305.673.7254
NAME OF LOBBYIST: Carter N. McDowell
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 p rvlant to Section 2-482 of the Miami Beach City Code.
77'/7
(ignature of LobbyiE". Date
MIAMI 5 26210 8.1 70000/60139
F:ICLER\SALL\aFORMSILOBBYIST FORMSILobbyist Registration Form Revised 08-18-16 REG.doc
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