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Tim Alborg - Skinny Labs Inc. 6,Scoo'krS r I+ RECEIVED A'/'\iA\/\AIBEACH Office of the City Clerk IJUN 14 2019 1700 Convention Center Drive ��' OF MIAMI BEACH Miami Beach, FL 33139 305.673.7411 OFFICE OF THE CITY CLERK 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: Alborg Tim NAME OF LOBBYIST (Last) (First) (Middle Name) c/o 2350 Kerner Blvd., Ste. 250 San Rafael CA 94901 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 415-389-6800 N/A spin1@nmgovlaw.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: i Skinny Labs Inc. DBA SPIN ' O /'� , ioQ, l NAME OF PRINCIPAL (Last) (First) (Middle Name) d o 2350 Kerner Blvd., Ste 250 San Rafael CA 94901 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 415-389-6800 N/A spin@nmgovlaw.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS Pursuant to City Code Section 21482(li)(11)(a): A principal of taliV corporation, partnerhip,CP other entity who appears ED a lobbyist m behalf of th'a entity,without special compensation cg f!uf+iitigiALAIftfortili appearance, indirect,CL'contingent ft)azo--Y-i$ailMatfiC20••ositionf an item shall register with the Clerk as required by this subsection but shall not be required to •ay any registration fees. 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): Derrick Ko • 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): Derrick Ko, Euwyn Poon, Zaizhuang Cheng, Dmitry Grishin Page 1 of 5 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. Mobility Services a-S Coo 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 Commission and Staff 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/A • 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): 5,000 / nII y 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 xNo: 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 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 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 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 x 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 past election cycle. See Section 2-491 for more information. _Yes x 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: _Yes x No: If yes, has it been less than 12 months since the elected official s) whom you provided campaig consulting services was sworn inr 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. _Yes x 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: _Yes x No: If yes. were you promised or did you receive economic consideration in exchange for campaiq consulting servicesr. • TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [X]Yes[ ]No Amount Paid$ 46"So- 00 MCR# '122111 Date Paid 06" �'1 - tC Lobbyist Registration Form received and verified by: ----\A-500.) .5I1-1,01v/LQ F:\CLER\SALL,aFORMS\LOBBYIST FORM$‘Lobbyi t Registration Form Revised 09-2O-18 REG;doc Revised 09/20/2018 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 CA ENDAR 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 COMPENS ION ' RING THE REPORTING PERIOD.1 • Signature of Lobbyist: ----- Date C /9 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 repoi -g requirements. Signature of Lobbyist: �4 Date /q r/i Signature of Principal: I Date 040-0 I c VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of 1 lC.(1dot._ State of C A County of: 1--e 0 (1 County of: iA Savorn, (or affirmed)arid subsc ibed before mgr., Sworn to(or affirmed) and ribed before me this, __J day of )j&l.. , 200 by this=d , 20 , by J rn -411b0, Joel Aurora NAME OF LOBBYIST ., NAME OF PRINCIPAL _Produced ID _Produced ID V FORM OF IDENTIFICATION FORM OF IDENTIFICATION Personally K _Personally Known • i '; 1, , . �C C ita Cattle& C A ,itutak) Sig - ure of Notary Public Signature of Notary Public Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped 1 — —f _—•I,_• ---,+ a" '+.,y"r" RENEE PONCE LEMONIER X1'4 ,, Notary h eta of Honda. I (NOTARY SEAL) (NOTARY SEAL}I _, C» n4sbn N.6G 062203 1,1,, My Comm.Exp rrs Jan 12:'2021 ',''° , �� Bonded through National.Notary Assn. 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. Page 4 of 5 CALIFORNIA JURAT.WITH AFFIANT STATEMENT GOVERNMENT CODE§8202 N See Attached Document(Notary to cross out lines 1-6 below). E See Statement Below(Lines 1-6 to be completed only by document signer[s],not Notary) Signat6lF Of-DocuFnent Signer-No.4- -S ignatroe-of-DEXA t-SigneFNe7-2-e any) A notary-:public-or other officer completing this certificate verifies only the identity of the individual whosigned the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California Subscribed and sworn to {er-•affir ) before me Countyof MARIN % on this day of TSE 19 2019 , .-. by Date Month Year (1) RicHARDMAHER land 12) ), Y4 "' '"'' \. Nota",Public-California. _ Name Signer(s) of Sr z :- . Mann County 9 ►�� - L.. Commission#2269545 "`°` : ,ey Comm.Expires Dec 4,2022 proved:to.me on the basis. of satisfactory evidence .. to, be. the person(s) who-appeared before_ me. Signature' Signature of Notary Public . Seal Place Notary Seal Above . . OPTIONAL . Though this sectiun iu uftiurnal, cumpletiny'iliis.infunualliuri can deteralteretion ofthe obcument or fraudulent reattachment of this form to an unintended document. Demoription of Alttaahed Document Title or Type of Document: Document Date: Number of Pages: Signer(s)Other Than Named Above: ©2014 National.Notary Association •www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5910 , . MIAMIBEACH 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: Tim Alborg 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 pur uant to Section 2-482 of the Miami Beach City Code. afh Signat .re of Lobbyist Date F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Page 5 of 5 Camm, Patrick From: Rosy McCarthy <RMcCarthy@nmgovlaw.com> Sent: Friday,June 14, 2019 2:12 PM To: Camm, Patrick Cc: spin Subject: Miami Beach: Registration for Tim Alborg Hello Patrick, This email is a follow-up to our telephone discussion regarding additional information to include on Tim Alborg's lobby registration in Miami Beach. Accordingly, here is the information below: o Section II, Principal's Contact Name: Joel Aurora • o Section III: Matters pertaining to mobility services; e-scooter sharing regulations and/or related permitting o Section V: $5,000/Annually Thank you for your assistance with this matter. Please do not hesitate to contact us if you have any questions. Best, Rosy Rosy McCarthy, Senior Manager, Political Reporting Unit NIELSEN MERKSAMER PARRINELLO GROSS & LEONI LLP 2350 Kerner Boulevard, Suite 250 San Rafael, California 94901 t: 415.389.6800•f:415.388.6874 e: rmccarthy@nmgovlaw.com NIEL "ENi;,11,1ER {SIUER Please visit www.nmgovlaw.com for more information about our firm Join Us on Linkedln•Join Us on Facebook CONFIDENTIAL COMMUNICATION: This e-mail, including any attached files, is confidential and is meant for only the intended recipient of the transmission,and may be a communication privileged by law. If you received this e-mail in error,any review, use,dissemination,distribution,or copying of this e-mail is strictly prohibited. Please notify us immediately of the error by return e-mail and please delete this message from your system. Thank you in advance for your cooperation. 1 ro a �, ' m 0 , nc Q 5 z..-•.,....,,,,z.,,,,,,,,...,_,."-_,,,•,...,=,:.•-,., . � a O r MBF a z r o City Hall o 1700 Convention Center Dr. �- �: p Miami Beach FL 33139 : Q y : 305-673-7420 "` e z C7 Welcome N m Vs _ 003600-0068 Maria A. 06/14/2019 04:48PM 6 MISCELLANEOUS ~x� tit * ,'� � i �.. Description: NCR OPEN Q n (MCR) b �� m Reference 1: 423777 m - - � NCR OPEN (MCR) o 2019 :Item: NCR 1 C 850,00 NCR OPEN (NCR) 850.00 I850.00 " = Subtotal 850.00 Total 850.00 ' CHECK 850.00 Check Number008806 o Change due 0.00 '� • N Paid by: NIELSEN MERKSANER .�..� o ~' IDII!Illlllllllllllllllilllllll!!11!(1111111 Illlllllllliillillllll ;.,71,,, r.,--:.'.4.2. :n g .: L Q __...�o..,........�..,.. 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