Cynthia J. Brown - MDGLCC Foundation V GrkAci
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V 11 /' '.p V k? Ljt. Office of the City Clerk (?5-
1700 Convention Center Drive SEP 2020
Miami Beach, FL 33139
305.673.7411 CIT'; ( '(_ ,"rii:'1m nr:ACr'-I
OFF'CTi,CLERK
LOBBYIST REGISTRATION FORM .....w..__._.n
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
_ _ s or uch act on, •-ciso o -co' - :.tion that fore -. • n .- =, • -"-. .�_ __ ,• __.
Commission, or a City board or committee. The term specifically includes the principal as well as any employee engaged in lobbying
activities. The term"Lobbyist" 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
............ missioner-orpersonael-who-are-also•sought-to-be lobbied-shall•require--that-the-4obbyist-#Ile-a-m-amerldment-tctt cgistm iaa..f .
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:
Brown, Cynthia J
NAME OF LOBBYIST (Last) (First) (Middle Name)
Cenergy, LLC 1873 NE 154 Street North Miami Beach, FL 33162
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
786:21-070611 CErrercg yr i fta i l fi g Tait CSiTT—
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
Adkins, Steven Noel Steve@gaybizmi
ami.com
NAME OF PRINCIPAL (Last) (First) (Middle Name)
MDGLCC Foundation 1130 Washington Ave, 1st Floor; Miami Fl 33139
Beach
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305.673.4440 305.807.0595 Steve@gaybizmi„ ._.
�_....,..., ami.com
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
Pursuant to City Code Section 2 482 hartnership or other entity who`;appears as a'lobbyist on behalf ofthat •
en iy„wi ou.specta :compati
enson or:reimbursemeri for the•appearance,:w ether direct indirect, irlgent toexpress suppoli of:or opposition to
an;item shall registervi tth the C erk es:Feguged'ay this subsection but shall.not.be;requifed;fo pay::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): 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 5 of 541)
III. ISSUE TO BE LOBBIED:
• Describe with as much detail as is practical, including but not limited to a specific description where
_.._,...,..app1icable..of a.pending request for proposal, invitation to bid, or public hearing number.-._.......
1- . A A p• Ica ion — = 'isi or en er
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
Miami Beach VCA X
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._.u.
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
tel i n ,w
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):
$ 0
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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":
es o: re you o yinq 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 X 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?
-Jr' Pursuant to City Code Section 2-482(h), any person (except Ttiose 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
• e city clerk as required by this section, but shall not be required to pay any registration fees.
Ot I
Yes :f No: Are you representing a not-for-profit corporation or entity without special compensation or
reimbursement?
ta,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
•.•.-.•.-.,._. •.••. , 11 •. -• . ...' . '.. • .- • •. - • -. '.• - • .1 i• a• . •....-. . .10_. .. _
reimbursement for the appearance.
XYes _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
.--fellowing-the-swearing-in-of..any--elected--offieial(s)-for-whom-the-cat paigmeansuitant-provieled-campaign-ee lt'
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:
N/AIf yes,has itbeen less:than 12:months since:'the elected official(s:)':whom'you provided campaign
consulting:seniices;was sworn in?
Yes No:
6) Pursuant to City Code Section 2-482(a)(4)a., a lobbyist who has within the past election cycle provided campaign consulting
Yd"a"irifrotnst: .. e •e • e o miss o` w ic` o•• i • ac iv ity-rfi-b1'-ollie
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:
)f yes;were you`promisore3 did you ieceiv'eeconoinrc considerafion in.exchange tor.campaign
�Y� consulting services?
Yes_No:
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee f ]Yes No Amount Paid$ MCR# i f Pate Paid
Lobbyist Registration Form received and verified by: o, '
F.\CLPR\$ALL\aFOR4MS\LOpayi T.FORr4S\Lobbyist.RegistrationEprtnR'visad G3, t.20•REG doc. Revised 03/11/2020: ...
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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 ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENS N DURING THE REPORTING PERIOD.' '
Signature of Lobbyist: Date lib(11" o
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 famili- with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
the Miami Beach City Code and all eportir• requirements. /
Signature of Lobbyist: Date 7AMW
! t r7202 O
Signature of Principal: //
9 P �1 Date � `�S /�ZC.�
VII. NOTARY SIGNATURE AND-SEAL:
LOBBYIST: PRINCIPAL
State of State State ofotvkk%
County of: ,M IA3,M1 `bAE County of: �I,45I-d4(.-1 E
Sworn to(or affirmed)and subscribed before me, Sworn to(or affirmed)and subscribed before me,
by means ore physical presence by means of 1 physical presence
or 0 oAliine notarizatio or❑ online notarizat'
this cLS day of ,--7-39431- p, 20�, by this,day of , 2079 by
dl i`ca, J• f5 co�1U� S-tu 0.14_,\A3
k.
NAMEOFILOBBYIST NAME OF PRINCIPAL
Produced ID f b L VProduced ID Ft-- t L
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
_Personal! Kno n _Personally Know
S" ature of Notary Public Si Lure of Notary Public
Name of Nota , T sped, Printed or Stamped Name of Notary,Typed, Printed or Stamped
NOTARY S 1
JASON SALVATORE NOTARY SEAL)
( :� MY COMMISSION 0 HH 000062 ( JASON SALVATORE
f.-1" EXPIRES:September 14,2024 MY COMIMISSION#HH 000062
•.,,ee f,,,. wry nde�wtIt :1F••�oPQ RES September 14,2024
Bonded Toru Prblic U ..... EXPH
' The term"lobbyist"specifically excludes the following p� erg so s: eond��'n'ND�NPubric
Undenniters
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.
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I
MIAMI BEACH
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
c3.
NAME OF LOBBYIST: 01 vtlekk l u- r o W tl./
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 • _ ber 1 of each year, and the fee for such annual registration shall be
$500.00 , •rsuant o Section 2-482 of the Miami Beach City Code.
, it_ 7
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Signature of .o1 Date
F:ICLERI$ALL1aFORMSILOBBYIST FORMS\Labbyist Registration Form Revised 03-11-20 REG.doc
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