Mickey Markoff - Mickey Markoff V c- G7C-
RECEIVED
I/\/'Y `"L BE1'\ 2 Fl Office of the City Clerk NOV - 8 2019
1700 Convention Center Drive.
Miami Beach, FL 33139
305.673.7411 CITY OF MIAMI BEACH
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
entiredecision-making process on suchaction, decision or recommendationthat foreseeably will be heard or reviewed by the City
commission;or a City board or committee..The term specifically includes the principalas 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 completeananswer;use a separate sheet(s) of paper. Ifyouhave 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:
Markoff Mickey Dean
NAME OF LOBBYIST (Last) (First) (Middle Name)
10394 West Sample Road Suite 200 Coral Springs, FL 33065 ..
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
954-649-4771 . 954-649-4707 " .. . . mickey(a�usasalute.com.
LOBBYIST BUSINESS.TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II: PRINCIPAL INFORMATION:
Markoff Mickey Dean
NAME OF"PRINCIPAL (Last) (First) (Middle Name)
10394 West Sample Road . Suite 200 _ Coral Springs; FL 33065
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
954=6.49=4771 954-649-4707.- . mickey anusasalute.com
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
AKEIEffn tbUD Code @Ming fligalftiga e corporation, partnership,(oI?c€l p + o appears Ma lobbyist(oh W`lp (TOO
• Mita itliClIBtvall compensation C1' ?ap(11D-..-sirincxx.r {p contingent,l37 GENGIM.su•.ort day o..osition l
A=WI l it ViSthe.MOM •�l`/ AS>,`ik • - • Melia�•Lo . .mr!k?n agotkaatzf .
If the principal is aCorporation, 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): Mickey Markoff
• NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION,PARTNERSHIP OR TRUST(if none,write NIA): Mickey Markoff
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III. ISSUE TO BE LOBBIED:
Describe with as much detail as is practical, including but pot limited to a specific description where
applicable of a pending request for proposal, invitation to bid, or public hearing number:
• Funding request from.the Miami Beach Visitor Convention Authority for 2020 National Salute to'.
America's Heroes
IV: CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4), listtheCity Commissioner or City personnel sought to be
lobbied, and whether the lobbyist has enteredinto 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 thesubject contractual relationship.
Full Name of Individual and Contractual Relationship (If yes,explain) YES NO
Title of Person to be Lobbied
Eileen de la Cuesta-Selva,Assist Dir : MBVCA. X
Pursuant to City Code Section 2-482(g), every registrant shall berequired to statethe 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):
N/A.
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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":
YesX.No: Are you lobbying on a present or:pendinq bid for goods, equipment or services, or ona 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 Section2-482(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 anyitem,shall register with
the city clerk as required by this section,but shall not be required to pay any registration fees.
_YesX_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,technicalor 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 oropposition 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
reimbu me t for the appearance.
se tio Areyou providing only scientific, technical or other.specialized .information; appearing as a
representative of a neighborhood association without special compensation orreimbursement 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 Section2-491 for more information:
Yes)(NO: Have:you provided campaign consulting services to an incumbent member of the City Commission
within the past election cycle?If yes,pleaselist the incumbent member(s)of the.City Commission:
Yes No:. If yes, has it been less than 12 months since the elected official(s) whom you provided campaig
,consulting services was sworn in?j
6) Pursuant to City Code Section"2-482(a)(4)a., a lobbyist who has within thepast 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 disclosesuch particular
service before lobbying the City Commission at a public meeting.
Yes XNo: Haveyou provided campaign consulting services town incumbent member of the City Commission
within thespast 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 campaig
t"onsultingrserd6'??I.- —
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY•
Annual Registration fee: [ ]Yes[1]No Amount Paid$ MCR# CILIA 5 i-F` iQLP Date Paid
Lobbyist Registration Form received and verified by:
\CLFr:\ JLi-.lal ORES kLGraf YLSi FO ISAI.ob;%visf rde?r8ccr7 ion Corder Revised QS•2ff-19 6:CG.ot Revised 09/20/2018
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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 ENGAGE 'T LOBBY: STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPEN D HE REPORTING PERIOD.'
Signature of Lobbyist Date November 8. 2019
I do solemnly swear or affirm that all of th foregoing fact statements, and disclosures in this form are true and correct,
and that I.have read or am familiar with the provision c•ntained in Chapter.2, Art:VII,Division 3;entitled "Lobbyists' of
the Miami Beach.City Code and all reportir• uire, ej
Signature of Lobbyist ' �� Date November 8, 2019
Signature of Principal: /.4.1 /%�®� Date November 8, 2019
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST:_ PRINCIPAL
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State of 'kk State of fi '(14
Countyof: . , \J -t County of: J%lC�
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m h sorto(oor aaffim�ed and subscribed before rote
Sworn to(or affirmed)and subscribed before me ) "l
this db day of . \ . . , 20e by. KE. 201, by
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NAME OF LOB4YIST NAME OF PRINQIPAL
_Produced ID.. Produced ID. . •
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
X
Personally Known Personally Known.
Signature of Notary Public Signature�Jof Notary Public
L(rrrn LWI Alatirrc-H L/1fr2
Name of Notary,.Typed,:Printed or Stamped. Name of Notary,Typed, Printed or Stamped
(NOTARY EAL)., __ _ (NOTARY SEAL)
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sa�4 Notary Public=Stats of Florida- . 1'; Notary Public=State,ot Florida-
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1 The term"lobbyi , +. IeiRgi?hktll ( 'sr` My Comm.ExpIres Nov 8,2020
•. n' Sondfd ary : ` .) ' ,` nded through National Notary Assn.
Expert witnesses r�specialized information or testimor�."
only appears as a representative of a neighborhood association without compensation or reimbuFsement for the appearance, whether . .
direct indirect or contingent,to express support of orr opposition to any item; and any person who only appears as a representative of.
not-for-profitcommunity basedorganization for the purpose of requesting a grant without special compensation or reimbursement for
the:appearance.
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MIAMI BEA l
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: Mickey Markoff
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 April30thof 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, forthe 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 eac year, and the fee for such annual registration shall be
$500.00 purs .n to Sectio of the Miami Beach City Code:
/a-, AZ4 November 8,2019
Sig !Ire of ob..y'.'t Date.
F,ICLERISALL1aFORMS\LOBBYIST FORMS1Lobbyist Registration Form Revised 09-20-18 REG.doc
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