John K. Shubin - Bath Club Entertainment ,4--1--,,k c„._,_,"
m Atv,\ BEACH
Office of the City Clerk R iE C I V E fl
1700 Convention Center Drive
Miami Beach, FL 33139 201!FEB 15 PM 12: 02
305.673.7411 C
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LOBBYIST REGISTRATION FORM -; ;; :t C!TY CLEI-: :
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:
Jr 5I N Sohn K ,
NAME OF LOBBYIST (Last) (First) (Middle Name)
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street)
(City) (State) (Zip Code)
- 1l � JJ sha •h_'Mb .C.
01
LOBBYIST BUSINESSTELEPHONE NUMBER
CELLULARTELEPHONE NUMBER iL ADDRESS
II. PRINCIPAL INFORMATION:
NAME OF PRINCIPAL (Last) (First) (Middle Name)
64
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PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
e.,FLA Ulf CC100 P-etWe5tQfP.Cr-fr)
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(if none,write N/A): it.141C— 12-40
boktikt.� Pei i to
• NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST(if none,write N/A): N IN
Page 1of5 /
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.
I\ic(f Sc iSs i ek kks4 tn A-hp OPrust
CALb coria ur1 'Wb.rnitke,ti
a5SOuo-non .
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
Jimmy Morales -City Manager
Thomas Mooney—Planning Director
Hernan Cardeno—Code Compliance Director
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(if none,write N/A):
N
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):
Akisol h(-
Page 2 of 5
The following six(6)questions MUST be answered:
1) Pursuant to City Code Section 2-488,entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues":
_Yes_[flo: 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 v 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 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 "No: 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 %/No: 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 2-491(1), no campaign consultant shall lobby the City Commission for a period of 12 months
following the swearing in of any elected official(s) for whom the campaign consultant provided campaign consulting services
within the ast election cycle.See Section 2-491 for more information.
_Yes lo: 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:
_Yes t/No: If yes, has it been less than 12 months since the elected official(s) whom you provided campaign
consulting services was sworn in?
6) Pursuant to City Code Section 2-482(a)(4)a., a lobbyist who has within the past election cycle provided campaign consulting
services to an incumbent member of the City Commission (which lobbying activity is not otherwise prohibited by Code section
2-491) 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.
INo:_Yes 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:
_Yes t o: If yes, were you promised or did you receive economic consideration in exchange for campaign
consulting services?
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [)C1 Yes[ ]No Amount Paid$ �S(.• )MCR# LOCI 1 Date Paid 02 `f
Lobbyist Registration Form received and verified by: �N p�3°" .) wv
F, CLER18A1118FOR1451LOBBYIST EORMS\Lobb}[ t Regtstrat;on form Re88se 01-0. 18 REG81tx Revised 01/01/2018
Page 3 of 5
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.'- r
Signature of Lobbyist: -- �'�-��� Date Fe ( r\j % aolb
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 F2b1 UQY\( 00 1b
Signature of Principal: 4`""' Date R. )( or q cj a.016
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of Th--Idly: State of Fla IdC�.
County of: ' A Qs`i 1 ` County of: Km r ' C.
Sworn to (or affirmed)and subscribed before me Sworn tp (or affirmed)and subscribed before me
this a day of -1-Q1-4()a.r� , 2018 by this CgI"day of 1e h (UOt(y , 20/12)by
Soh r\ QDKibi +� �-lae� iD 1 iQvt e regi
NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced ID _Produced ID
FORM OF IaENILEICATION FORM OF IDENTIFICATION
personally n ' 'ers. - Kn
Signature of Notary Pub Ic -- Ignature •' Notary Public
Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped
RUTH QUINTAVALU
(NOTA myCOMMISSION S00046314 (NOTARY SEAL). .:.:::e
1 .2 "4'
, EXPIRES:March 9.2021 : - RUTH QUINTAVAW
,:,- ,: N•ny p qc Und•rvnit�s Y: . MY COMMISSION S GG 046314 I%
"'•Bf:,•i ;; :,;s EXPIRES:March S.2021 Ip
••�:::aP• BOr did Thni Nobly Public Unde, ttrs1 i
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.
Page 4 of 5
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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: 1\
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.
ve\--AKIN % @oie)
Signature of Lobbyist Date
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 01-01-18 REG.doc
Page 5 of 5
Salvatore, Jason
From: Ruth Quintavalli <rquintavalli@shubinbass.com>
Sent: Friday, February 23, 2018 4:16 PM
To: Salvatore, Jason
Subject: RE: Shubin Bath Club Registration
Hi Jason,
The information/name is as follows: Roy Donahue Peebles is the CEO of The Peebles
Corporation and the Authorized Member of Bath Club Entertainment, LLC.
Have a great weekend!
ShubinBass
Ruth Quintavalli
Shubin & Bass, P.A.
46 S.W. 1st Street,Third Floor
Miami, FL 33130
Phone: (305) 381-6060
Fax: (305) 381-9457
rquintavalli@shubinbass.com
Attention:The information contained in this e-mail message is confidential information and privileged. The information contained
herein is intended solely for the use of the individual(s)named above. If the recipient of this message is not the intended recipient,
you are hereby notified that any distribution or dissemination of this communication is strictly prohibited. In the event that you have
received this communication in error,please contact the sender by reply e-mail and destroy any and all copies of the original
message.
From: Salvatore,Jason [mailto:JasonSalvatore@miamibeachfl.gov]
Sent: Friday, February 23, 2018 11:16 AM
To: Ruth Quintavalli<rauintavalli@shubinbass.com>
Subject: RE: Shubin Bath Club Registration
Importance: High
Good morning Ruth,
One last thing regarding this registration. A chief officer name was disclosed N/A on the form, however Bath Club
appears to be related to a company called Peebles Corporation. In this case, a disclosure of no chief officer cannot be
possible because Bath Club/Peebles is a corporate entity registered at the Florida Department of State. Do you know
the name of the chief officer for Bath Club or the parent company?
Thank you,
1
S
10 AVM, I BAC H
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: Ruth Quintavalli [mailto:rauintavallishubinbass.com]
Sent: Thursday, February 15, 2018 12:03 PM
To: Salvatore, Jason
Subject: RE: Shubin Bath Club Registration
HI Jason,
The information to be incorporated onto section IV. concerning contractual relationship — response is no
(for all three) and the section concerning any business, financial, familial or professional relationship
is n/a
Thank you for your help!
Have a great day.
ShubinBass
Ruth Quintavalli
Shubin & Bass, P.A.
46 S.W. 1st Street, Third Floor
Miami, FL 33130
Phone: (305) 381-6060
Fax: (305) 381-9457
rquintavalli anshubinbass.com
Attention: The information contained in this e-mail message is confidential information and privileged. The
information contained herein is intended solely for the use of the individual(s) named above. If the
recipient of this message is not the intended recipient, you are hereby notified that any distribution or
dissemination of this communication is strictly prohibited. In the event that you have received this
communication in error, please contact the sender by reply e-mail and destroy any and all copies of the
original message.
2
From:Salvatore,Jason [mailto:JasonSalvatore@miamibeachfl.gov]
Sent:Thursday, February 15, 2018 12:01 PM
To: Ruth Quintavalli <rquintavalli@shubinbass.com>
Subject:Shubin Bath Club Registration
Hello,
Please reply with the information requested for page 2 of the registration.
Thank you,
`v\ BEACH
Jason Salvatore - Office Associate 111
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.
3
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