Robert M. Moehring - Tracey Fishty I \ c c+.
MI AM I B EAC Office of the City Clerk
1700 Convention Center Drive
Miami Beach, FL 33139
305.673.7411
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 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:
MD P-k 7 MA-Pritt/
NAME OF LOBBYIST (Last) (First) (Middle Name)
Po P10 *t' to LiN€ot.N S`t s o 6 M/AHl B�AfI`� !� 3313 4
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) ' (City) (State) (Zip Code)
Dom-trl Y-0011 los-1911-3(req. -TGbMAo_cs ov_f v.as!
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
Fist-Pry -fl4Acwi
NAME OF PRINCIPAL (Last) (First) (Middle Name)
119 Z+'l /o.Jt t&i Cis 15,-r-rft:› r1!AK teztYli F 33I 31
PRINCIPAL BUSINESS NAME AND ADISRESS (Number and Street) (City) (State) (Zip Code)
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: Nit/A_
• NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: w
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
prpposal,irkvilation4.9 bid,or public hearing number. TO
�f[St�R�G Weira V 411nJ XeV1ttt/ Ao•4PA 1 pLAA/A/M' M 4FD, 1-21/1F-Al &4WD, 134012
� .D.)0crM ?Jr:.� �Ar1/49 - 17Fv o t-itrrr aft -1
l /TITO Ani cry cir/Pt rox/, iF"
WWcAP V� grutiai 7a 1 Pf tV A-f . ;2 ojor i-i'm' soke 1=6,
•
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
woroIC1 ¢3� mat•vi, .i7uN,Ic wc�R-'s ANn Na jJtr
Vip -wr5'f1f`Pbi Doll,14-91313oA 7.4/Twr-
i-r41 4titt sstc?( , Atm t ct ' t 12Eve-w P' -4.4- A
Coµtt)-(�� ,115 wiFctess, /
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: 464
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note that a
contingency fee is prohibitpursuant to City Code Sec. 2-485.3):
2co / i4Q.
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 .14o: 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*lo: 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 lobbying the City Commission at a public meeting.
_YesKNo: 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.'
Signature of Lobbyist: Date 673//u,�f
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.
34
Signature of Lobbyist: . Date
Signature of Principal: Date
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of FL-0 PIM State of
County of: MIAMI,be- County of:
Sworn t (or affirmed)ands�ubssscribed before me Sworn to(or affirmed)and subscribed before16
me
this I(G'' day of N1 h'1` ,2016, by this day of by
i-c t3 2r i'irrrlC7
NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced ID Produced ID
FORM-OF-IDENTIFICATION FORM OF IDENTIFICATION
.personally Knewn Personally Known
'
4 iI
Signature of otary'H ublic Signature of Notary Public
A-EJ A goMAN
Name of Notary,Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped
(NOTARY SE -�' Maris ROM (NOTARY SEAL)
.� Com 166010111
Alpiyypt1Q'��,s
0 ' K�VMPLETED BY CITY CLERK'S STAFF ONLY �/df�
Annual Registration fee: [ ]Yes[11 No Amount Paid$ �z'iO MCR# 6 01-(ti Date Paid U S
Lobbyist Registration Form received and verified by: ..Li 59•'V
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.
Salvatore, Jason
From: Robert Moehring <robert@domodesignstudio.com>
Sent: Wednesday, May 31, 2017 12:47 PM
To: Salvatore,Jason
Cc: Maria Lourdes Roman; Francisco Llado
Subject: Lobbyist Registration - 119 E 2nd Ct
Hello Jason,
Please accept this email as confirmation that I will be representing the project at 119 E 2nd Ct, Hibiscus Island,
per the lobbyist application submitted this morning. Note that the property owners representative signed on the
lobbyist signature page in error, so we crossed it out and provided a duplicate page with my information and
signature.
Kindest Regards,
Rob
itc)431 I:1 \IOEI IRING
PRI.N( 1PA1..
:architect. landscape Architect, l.lIB AP
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1 he information contained in this electronic communication;as well as in any attachments.is privileged and confidential and intended solely lir use by the
addressce(s}. Any other use.dissemination.or copying of this electronic communication is strictly prohibited and is an interference with Domo Studio 1 1 t2.and its
confidential business relationships. ft'you received this communication in error,please notify me immediately and permanently delete the original and any electronic or
printed copies of this electronic communication, Domo Design Studio makes no representation regarding the absence of any virus in any attachment and expressly
disclaims any responsibility fir any damage suffered Ilam the presence of a virus,
1
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
LOBBY! T HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENSA 0 DURING THE REPORTING PERIOD.-
' / Date l 4��'Ignature of Lobbyist: ��
I do solemnly swear or af at all of the foregoing facts, statements, and disclosures in this form are true and correct,
and that I have read or -,Li .mi'. with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists"of
the Miami Beach City Code an, report� :quirements.
t
Signature of Lobbyist: . Date
Signature of Princip6 ��---�� Date 3//
i
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of ' (�l State of
M 1 i�M( p (, Countyof: /n 1 qM I PAM
ounty of: .
Sw. to(or affirmed) .is s -,scribed before men Sworn to(or affirmec)-and subscribed bef20e
this . day of ,201 by this LT day of wl by
NAME OF LO=:YIST NAME OF PRINCIPAL
' Produced I' _Pr duced ID
-•RM OF IDENTIFICATION FORM OF IDENTIFICATION _'
'
y- _
Personally now __Personally Kno = ,
Sgnatur: otary Public Signature of NAarry Public j
ifvvv
Na : of Notary,Typed,Printed or .tamped Name of Notary,Typed,Printed or Stamped
(' OTARY SEAL) (NOTARY SEAL)
TO BE COM•LETED BY CITY CLERK'S STAFF ONLY
', nual Registration `
fee: [ i Yes[ ]No Amount Paid$ MCR# Date Paid
Lobbyist Registration Form received and verified by: Revised 08/18/2016
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,
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
NAME OF LOBBYIST: g0bE FT MOEvI2-1 tvG
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.
05A,aI i
Signature f Lobbyist Date
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 08-18-16 REG.doc
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