Robert Moehring - Jody Glidden 5O [it
•
I/ \�.I B�� Office of the City Clerk
NOV =5 2019
. 1700 Convention Center Drive
Miami Beach, FL 33139 "
: . .
305.673.7411 : . CITY OF NAMBEACH.
• LOBBYIST REGISTRATION FORM
OFFICE( F lfN-11E lClllf r CLERK
•
Lobbyist means all persons employed or retained,whether:paid or not, by a principal whoseeks 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;orany action,decision or recommendation of any City personnel duringthe time period of the
entire decision-making process on such action; decjsion 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 aswell 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 "ri/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 amendmenttothe registration form:
The lobbyist has a:continuing duty to Supply:inforrriation and amend the forms filed throughout the period that the lobbying occurs.
' Separate registration.forms"shall be:required foreach principal:represented on each specific issue. : .
I. LOBBYIST INFORMATION: •
Moehring: "R.
obert Martin "
NAME OF LOBBYIST, : • (Last) (First) (Middle Name)
•
DOMO Studio LLC, 420 Lincoln Road, Suite 506 Miami Beach Florida 33139
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)"
305-674-8031 305-984-3624 robert@domodesignstudio.com
LOBBYIST BUSINESS TELEPHONE NUMBER : CELLULAR TELEPHONE NUMBER • EMAIL ADDRESS
•
•
II. PRINCIPAL INFORMATION:
GLIDDEN. . JODY
• NAME OF PRINCIPAL : (Last) (First) (Middle Name) -
3726 PRAIRIE AVENUE . MIAMI BEACH FLORIDA 33140
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) r (State) (Zip Code),
305-793-8514 .jody.glidden@gmail:com.
• PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER " EMAIL ADDRESS
•
If theprincipal 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 NIA): N/A:
•
• 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/A;
•
. • .
•
Page 1 of 5 •
• Development Approvals and Permitting Issues,including,but not limited to Historic Preservation Review Board,
Planning Board,Design Review Board;Board of Adjustment,Land Use Development Committee,end City Commission,
if necessary,relating to the property located at 1635 W 22nd Street,Miami Beach F1,33140.
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.
Development Approvals and Permitting Issues, including, but not limited to Historic Preservation.
Review Board, Planning Board, Design Review Board, Board of Adjustment, Land Use Development.
Committee, and City Commission, if necessary, relating to the property located at 250 S Hibiscus Drive,
Miami Beach FL 33139. ..
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 '(paidor 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
Planning, Building, Publlic:Works and Fire Dept
X
Staff' .
PB, DRB, HPB, BOA,City Commission, and Land X
Use Development Comittee, as necessary
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 animpropriety, 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):
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):
$250/hr
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�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":
• _YesNo:. 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" asset forth in
Section 2-481)who only appears as a representative of a not-for-profit corporation or entity without special compensationor
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 4No: 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 specializedinformation 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 XNo: " . 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 2491(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%.No: Have you provided campaign consulting services to an incumbent member of the City Commission
within the pastelection cycle?If yes,please list the incumbent member(s)of the City Commission:
•
_Yes%lo: . If yes, has it been less thant12 months since the elected official(s) whom you provided campaig
consulting services was sworn n..
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.
YesXNo: 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 No: If yes, were you promised or did you receive economic consideration in exchange for campaiq
consulting •
senricesr
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY e
Annual Registration fee: [ .]Yes No Amount Paid$ 3Si•(MICR# 1-12.5//2 . Date Paid P 1/ if g
(�(J
Lobbyist Registration Form receivedand verified by: ' -�� U Vrf .
F:\CEEB\$ALL\aFORnS\LO5EYIS•r FORTIS\Lobbyist Registration Fora Revised 01=01-1 .doc . 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.'-
Signature of Lobbyist: /4'171/14.6 —
Date //10 v/b7
.
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 pd- eporting requirements.
Signature of Lobbyist: Date ' Ph 5///7
Signature of Principal: �` Date Vol
VII. NOTARY SIGNATURE AND SEAL:
•
LOBBYIST: PRINCIPAL
State of 1'Z(lrbc C ' ' State of 7 l
County of: G1 _ County of: '1"-- \
Swor to(or affirmed)ctitdsubscribed'before me SworJ�19�(or affirmed)and subscribed before me
this LtrA. day of 14lid .20H,,by this .qday of . N 1-y3e2--• ,20( ,, by
-(3.W-7-- chI Jo DY L/�p .
NAME OF LOBBYIST NAME OF PRINCIPAL
Produced ID . i _Produced ID '
/ FORM O- ++ TIFICATION ' FORM O. IDENTIFICATION
v Personally Kno /Personally Known
— /
Signature'of Notary 'ublic Signature of Notary Pu• c
70w`a ELlc,vkt'A"
Name of Notary,Typed, Printed or Stamped Name'of Notary,Typed, Printed or Stamped
C DAVID SOLOMON -
(NOTARY SEAL) ic„_ MYv0MMISSION#GG205481 - (NOTARY SEAL) ,1 `",s17-1,67-- DAVIDSOLOMON�
' ono= EXPIRES:August 10,2022 lc ` ' / MY COMMISSION f GG 205481 !F
{ F'° Bonded Thru Notary Pubric Undenm' r { EXPIRES:August 10,2022
t L „;°• Bonded Thru Notary Public UnderwritersS
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
MIAMI BEA
City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfi.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: . . .. -f — �7
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 fin.e.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 Statementor pay .the
assessed fines after notification; .
Any lobbyist, who fails tofile the required Statement by April 3Q of each year, shall be
automatically suspended from lobbying until all finesare 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 regardto 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.
/f/oy •
Signature of L.bbyist Date
. . . - F:\CLER\$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 01-01-18 REG.doc -
. .
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