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Andrea Tovar - Coca-Cola Beverages Florida, LLC CCc'c1ek RecevED MIAMI BEACH. JUL Office of the City Clerk — 7 2021 1700 Convention Center Drive ' '�'7!,; Miami Beach, FL 33139 t-,11/4,t‘,i1i`1lBEAQH 305.673.7411 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 indudes 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 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: Tovar Andrea NAME OF LOBBYIST (Last) (First) (Middle Name) Corcoran Partners 19401 Shumard Oak Drive Land 0' Lakes Florida 34638 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-604-7910 786-357-5533 andrea@corcoranpartners.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Pond Deborah NAME OF PRINCIPAL (Last) (First) (Middle Name) Coca-Cola Beverages Florida, LLC, 10117 Princess Palm Avenue, Suite 100,Tampa, Florida 33610 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 813.327.7296 n/a dpond@cocacolaflorida.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS •ursuan to Ci Cad c e'ction 27-'4:2(h1(i n GQ principal of tale corporation,parFertlip,CT other ent' who r.o+.sia3 Epp liatibyliit C b'eh'alf of f1T en i ,uffnmilspecial compensa .n Cpm fort irj appearance, - u< •. -g CI?contingent 113®;7 .e. ASO o e e osi'on itt o an tem shal req er wi he Ole as required by this ubsection b shall not be required.o pay any reqistratie. ees 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): Troy Taylor • 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): Cardinal Intermediate Holdings, LLC l. Page 1 of 5 I Ar- DocVerify Page 1 of 5 1698595252092 •ff want H 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. Existing contract and partnership with City of Miami Beach and potential contract renewal. 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 Alina Hudak, City Manager x Dan Gelber, Mayor x Commissioners Micky Steinberg, Mark Samuelian, Michael Gongora, Steven Meiner, Ricky Arriola, x David Richardson 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 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 • P. N N 7: 0) m • 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): Corcoran Partners represents Coca Cola Beverages Florida at a flat rate fee to perform statewide governmental relations and consulting services across Florida before all state and local governments. There is no specific or dditional co pensation resulting from r presentation of Coca Cola Beverages Florida before the City of Miami Beach, N nor does any contingency agreement exist p do ']5T'� 7' c fii5t Cc tt FV -/ Page 2 of 5 DacVerifyID:AF8B7DSA-9594-4D99•BCB5-898595252092 I Paget of 5 Ln8595252092 I 1111 mom III mvrrr.dofve:ify.oan 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": X 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 2490,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 XNo: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement? 4) Pursuant to City Code Section 2481, 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 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 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 XNo: 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 XNo: !f yes, has i been less than 12 months since he elected official(a) whom you pro..ided campaic conssultina services w s 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 ti service before lobbying the City Commission at a public meeting. —Yes XNo: 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: pN N ONi Yes XNo: If yes, were you promised or did you receive economic consideration in exc ange for campaip consulting servicesr TO BE COMPLETED BY CITY CLERK'S STAFF ONLY m Annual;Registrationafee E Yesi[ iJ No�Amount�Paid S C MCR#r �� ' •:z"t Date Paid ?�'� t r cfF i $'< y'1 J �f'N j�� ,' z i i�,�F S•r �._ v� ',.+5 aei �r t,s� r i> e s i,�ll. `�` ,r 1i'.+ k".rl M aJ ``. 3. Lobbyist R�glstratian?Form,;recenredkantl v nfiedlby 5 �c�a r �, o .: a _' :. ` s _ > Revised'03/,11/2020 Page 3 of 5 DacVerify ID:AF8BTD5A-9599-0D99•BCB5-B98595252092 ,n'py, 1011 II I �vww.dxJericorn Pa e 3 of 5 3B98595Z52092 II11II11II R6@9GcK 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 I 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'T e DURING THE REPORTING PERIOD.1 Signature of Lobbyist: , ..I gh Date July 1, 2021 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 - I,•orling requirements. Signature of Lobbyist: b.. ••�!:11 Date July 1, 2021 07/06/2021 Signature of Principal:L1e6o,kpond —�' —1 Date VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State ofCsu4,1rz. State of_Florida County of: PQ4 CO County of Hernando Sworn to(or affirmed)and subscribed before me, Sworn to(or affirmed)and subscribed before me, by means of 0 physical presence by means of 0 physical presence or 1:fonkie notarization, or 0 online notarization, this / day of , !.���eCr ,20a(by this_day of_07/06/2021 ,20 ,by 7).6 re Cc `L O(J2,1 Deborah Pond NAME OF LOBBYIST NAME OF PRINCIPAL Produced ID Produced ID Z FORM OF IDENTIFICATION FORM OF IDENTIFICATION 0 E rc Personally Known _Personally Known �I ure of Notary Rubii C�j Signature Sbnerlm.25075061310.807 A.i Chef/- -iCl"4ZZi/CJv/S Julie Josephitis Name of Notary,Typtipkr,intqchaffiktimaguRts Name of Notary,Typed,Printed or Stamped N Comic ssion0 GG 121994 _ _ __ N (NOTARY SEAL)y�, ExpiresAlugust7,2021 (NOi JulieJosephitis 4 Nornpa� 1:n161111ra8+ tioGrySanbc Commission#GG 266948. t• Notary Public-State of Florida 0 / Igy Commission Expires Oct 15,2022 cn 'The term"lobbyist"specifically excludes the following persons: ICi P. s ��-- m Expert witnesses who provide only scientific,technical or other specialized iniormannotestimon in pumic meetings;anY person who 0 only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether 4 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. m The foregoing instrument was sworn/affirmed before me by means of online notarization by Deborah Pond.I a personally know Deborah Pond. • I1`fy.com 7DSA5594-0D99-BCe5.898595252992 - ,III ,I III II Page 4 of 5 4B98595252092 MIAMIBEACH City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov Office of the City Clerk Rafael E.Granada,City Clerk CityClerk@miamibeachfl.gov Tel:305.673.7411,Fax:305.673.7254 NAME OF LOBBYIST: Andrea Toyer 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 z 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 $500.00 pursuant to Section 2-482 of the Miami Beach City Code. .4� July 1, 2021 Signatu - • Lobbyist Date o , QI F:ICLERI$ALL1aFORMSILOBBYIST FORMS1Lobbyist Registration Form Revised 03-11-20 REG.doc r Page 5 of 5 IDocVerifyID:AF887D5A-9594-4D99-BCB5-898595252092 Pa 5 of5 5698595252092 1111 III I www.doc verify.com 11 QAC dociferify CCVEtit'* Lobbyist-Registration-Form-Revised-03-11-20-REG -jj 7.6.21.pdf DocVerify ID: AF8B7D5A-9594-4D99-BCB5-698595252092 Created: July 06, 2021 13:44:23 -8:00 Pages: 5 Remote Notary: Yes /State: FL This document is a DocVerify VeriVaulted protected version of the document named above.It was created by a notary or on the behalf of a notary, and it is also a DocVerify E-Sign document,which means this document was created for the purposes of Electronic Signatures and/or Electronic Notary.Tampered or altered documents can be easily verified and validated with the DocVerify veriCheck system.This remote online notarization involved the use of communication technology. Go to www.docverify.com at any time to verify or validate the authenticity and integrity of this or any other DocVerify VeriVaulted document. • E-Signature Summary E-Signature 1:Deborah Pond(dip) July 06,2021 13:53:41-8:00[D252A1 1 1932F][4.53.175.130] dpond@ cocacolaflorida.com(Principal)(Personally Known) _ � ti E-Signature Notary:Julie Josephitis(JCJ) ,$• ' ; July 06,2021 13:53:41-8:00[CCOBO1C5A56C][173.171.58.54] rI 111l jjosephitis@cocacolaflorida.com I }�' 1+ F •' I,Julie Josephitis,did witness the participants named above electronically + I`' F. sign this document. 7A- IN : f l+}r� r,r ` Fr 111(1111 Illi 11111 11111 111111 1111 111 1111111 11111 11111 Ilii 111111 III Illi 111111 11 11111111111111 1 1111 111 111 UN[III 11111111111 NUMMI MITI DocVerify documents cannot be altered or tampered with in any way once they are protected by the DocVerify VeriVault System.Best viewed with Adobe Reader or Adobe Acrobat. All visible electronic signatures contained in this document are symbolic representations of the persons signature,and not intended to be an accurate depiction of the persons actual signature as defined by various Acts and/or Laws. IDocVerify ID: wv daver'dycan AF8B7D5A-9590-0D99•BCB5-898595252092 [generated Cover Pagel B98595252092 I imEneinsilli Mtseellaneaus Cash Receipt CITY OF':,;;;.'''-',::‘:::-;: -': F MIAM#.BEACH r(-,;:::?;...,-,,:;‘,,,,, , Mo�428261 Q CI to; Carus ,3 Che, #r° ; ,7 : s Caassh," 20 d Payment Amoun# 850 00 ' 1-„,,,,,,,,,,,', ' -,,:- �THtS,INFORMATION MUST 8E C.OMPLETED) Office of„Finance Director r ,,,,,,,,,,::.1A,,e,,w,,,, ,, ,,,,:,,,,,,,. ' r /Account NumbN'` t” a-?`, a ,s+ � „l r y° •' " y a lq