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Cynthia Jean Brown - MDGLCC Foundation Inc V c-Pc- Greury • • RECEIVED . M I AM i ',,,,i' it, 7.-AC,, L Office of the City Clerk DEC 14 2021 • 1700 Convention Center Drive . Miami Beach, FL 33139 305.673.7411 CITY OF MIAMI BEACH OFFICE OF THE CITY CLERK LOBBYIST RBGt$MATION FORM Lobbylat-:rneati&.altpier'sbria:arnOloyed•oerata694,whpthat!paid.or.not, by a principal who..a-aeiwid*catiragajimpa#06".,,.06f. t4r triodifidatian.,..pf any ottlinaii66, rapOiptiOn,i0tiali-Or decikipri,of'anY commissioner; atiYadtion.;clojiijit:!tontrengation.of the-.City Managordiany City board'ytoinniit:teepr any action,004iaigry,o.reOcirrirneridation.OfiatiY:CitY.Persomei during time We Oritiro.090$10rilriaking,propmf,bn such action, detittat,Or.recRimarigatiori that foreApeat4 Wir be heard or to/Jawed by Op. City commission or a City board'oreorninittee;:iiialartn:,spftftaiViriduci4 iilo principal as well as anyk,'.eiiii5f,p94:;_qnspgocmh,iii*.i0.9. activities. The-tariii.Uoyiar f*,appOio*seiWiaria:.Please Warta City Code Chapter Article piyiaidii•s3,..erititiati"Cobb' for*fitiOnat itifaiii)ation. Instructions- Please complete aiipaptip4,of this fern,and submit' tho.coitOteted'kriti with iti applicable- fee,.tp.tliq:Ofkq ate:,City iceilrfico.tiff y;Iti:rirtds:i.tnimpenteti•O:40drOr,n,:ilirairt i'fa section,e u 44r7,:hrOantlethteeti tty.ofi•no4r%ra:iilof you have hi:atpiI:9 toOt:raenPortidngti(1:1?itiegiz' Commissioner or personnel who are aiio,a00iii tobalOOOle'dahalfraildiip,thatIneititibiii0 file.-an,,:ainenditientiOthe:;mistratiOnsfOrth. tt.),a:,10Oliylif tea a continuing duty to supply iivolo.atialiAN.Arrand:114"kititOt throughout the pariorr:lhat the lobbying occurs. *parptoragi§tratiorifonrt,s'4fiali.Oe.reOoire-d for•ego4piiiitiOal represent on 6gOli•ipadifloisttia'< • 1. .LOBBYIST itOORMATiON: :tito4eoF LOBBYIST (Laat) (First) . #40..: ' .P.*)- N 1 S71 S '' .'.' /vino c 53/ , . LOBBYIST BUS! NAME AND•ADDRESS. "(Number and Street) (City) . (State) '"' (Zip Code) • 4 ,.. ,. .. • .,7?‘ ' 2(0 .-i9ht•. • •, . • , .ie14.' • . ivl,iy4nA I . , ..-... ••,- 1.0BayisT404$,NE4sTELEPH.01\leM4MER, caltitAiVra1EPHONE NUIMER ' • t'0 PIA . • • II, PRINCIPAL INFORMATION: . . • , • . . -/C — ... , ...5—: ir,2,1 , 6?...- . . .. • NAME OFORINPIPAL,. (Last) • (First) • frT,D6464 Gi ifl, --C._ • I i?z) .bla sk(e\ 100. e_ . . ic 001, -C PRINCIPAL BUSIN SS NAME'AND ADDRESS . (1940.erand Street) (City) . . - (State) . (Zip Code) •_•• akii.&. L.- . ea& • ,coy\ i:?tili\rcIPAL 8V$INEsS-T448pHole,ftmsER, " CEILLORIELEPI4ON4•:NympER E AIL'ADDRp§ • • • 2-4 NfrOditit*O4Y,P000:'*aibii' Ekiii(1)(0",*iiii0:4i*Of..0,0t 0004tip/. P0t.trit*fkOtAl*Pn*:#It 000."* AYAJO*JAq101:***'#10. origty,: ottoikOtodappirrip*Ox'tt fainioarao.0010etti6:4140#*oilpo.,Wmtii 'iiir**Itiii*.4t;ot Ottijit60440. express support Of OrsmgOalti0616: an item ha!l register with the Clerk as tequired by lbs subSaCtio but shalt r.or be required to pa any registratiQ foes. If the Principal is a Corporation Partnership or Trust, the fOliciwliV. information MUST be provided pursuant to ciw:Caita„Sebtioh 24.62(c): :r 0 NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write N/A): - !Skye., Adxk 4 • NAME OF.ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE; INNERSHIP INTEREST IN SUCH CORPORATION,PARTNERSHIP OR TRUST(if none,write N/A):' .. , AA../47 . . • • __Z________.. . .- Page 1 of 5 • . . • • HI. 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. ' tb- er)L. &_ 0 &Act 41 0 i\- L -64 61- v 1st a ' V C Pr AAA- IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482 a .4 list the City lobbied, and whether the;lobbyist has)e tered into any contractualrelationship personneld sought to be with (paid d or unpaid)fe vice 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 relation ship. Full Name of Individual and Contractual Relationship (If yes, explain) Mal NO amminammagannTitle of Person to be Lobbied iii IMIMIIIIIMIIIMIIMIIIIIIIIIMIM 11111111110 IIMIIIIIIIIIIIIIIIIIIIIIMIMIMIIIIIII 1111111111111.11111.11111111111111 Pursuant to City Code Section 2-482(g), every registrant shall be required to state the extent of an business, financial, familial or professional relationship, or other relationshiy appearance of an impropriety, with any current City Commissioner or Cityp givingwho rise g an personnel who be lobbied as identified on the lobbyist registration form filed, is sought to List any Business, Financial, Familial or Professional Relationship, or other relationship a earance of im•ro•riet , if none write N/A giving rise to an z Art V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be.Specific. (Note contingency fee is prohibited pursuant to City Code Sec. 2-485.3); that a 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": YesTNo: Are,,U.:tabb.in .on al resent or endin .bid for bode 6 in'Meet or services or On-a. resent Or endin award for. oods-,equipment or serVice? 2) Pursuant to City Code Section 2-490,entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yesi.fto: Are, oil Jobb•in .on.a "endhf a fication int a Develo-rttent A reement With the tit' or a licatiort ,... . . . ,.. , . . . ler chen Cotionin eta ,deti" natian orichan etatheti ':''S•Future Land Use Ma"?.. 3) Pursuant to City Code-Seetion.'24182(h), any person Oxbopt.the-Se exempt from the definition:of"lobbyist as set ibeth-th' Section 2-4$11Whrionly.appears asa,repreSentatiVa of a not,forLprokdOrporation or entity without compensation-or reithbUrternentioriheAppeatanCe,:WhtherxiirOct et-irtbitedio pprp,wiopoq:b.rbt-64.osi(ipn to 4alt-40M...Shall register with :.. • • ,o city clerk aS eequired bylnip,Sootioni but shall not be reilbireetii0eYiany,regietratiOnfeeS'.; ... Yes.flo: Are. au; re retentiti :a ncit.for, rofit: corporation .or entity without special compensation or reirribursement?' - 4) Pursuantio:City-Code Section 2,481i:the term."lobbyist' specifically exclurkettlW:ftilleiivingj...p.efsoPs;,OPert Witnesses vitha, prokig.06iy.'stiehiliftbi technical dtottienspeCializeCi inforMatiber6tiestiinonyin public meetings;any person who only appeeiS, aS,a,represototive of,.inelObbprh9940$SOPlation without compensation bri:reiniburserneht fOr,the'eppearaticei whether direct, ibbititt or contingent to express support of or oppoSition to any item,and any.peribiirWbd onlYappearS..`.00.-a representative of npt-ferprofif .community tessd. organization for the purpose.of .requesting a grant without special compensation or reimburse 1 ..entfOr'the appearance; .. . _Yes. 0; Are on • rovidin ant . Soientific lectiniCat or Other .s ecialized IttforniatiOn• a earin .oS o ) . .. . . ., .,, ... .. . ,,.. re reSentativesz&-a.nerhbeilioortassoCiatiori Withatit S 'east nom eiliatiOn Cr reimbursernentiii re"reSentin" a hOt-for,' refit: baSed o anization far the; ' ur ase'Of re tiestin' a ' rant'Without! . ,. .. . _ . s ecial.compensation or reimbursement, 5) Pursuant to City Code Section 2441I),,..00 campaign ConSuitent.sh011 lobby the City Commission for a period of 12 months follow theswearing'in of any elected.ofgclai(sy friewbbin the :.campaign consultant provided campaign consulting services ...... . ... ,....., . , .. .,. WithinthapastateCtiontyCie See Section 2-491 for more Ye 4 11 ue.raosvtiecilee.d.c.•ttio.a n,.t t..i,..,..a„ci.ien?c.Iof nessultin se.rv.ic. eeta..:,7:incumbentremb"i'r of the city to• M'.m'is-t''.ie r fease.list,the.ncumbentrcrber s of the cityCommission: Y • ..• if,:'ite,hasq.it beerCieSe-then i'Inionthe.:Sittee'theleieded,effidial s ,whomc': iiii roVidedfcam it s ri, consuftm !sei,yjc was swornin?; .. . 6) Pursuant to City Code Section 2-482(a)(4)a., a lobbyist who haaWithirtjhs:posteleeticir OYOleorovicipili;carripaign'demitiltiPg services to an incumbent member of the City Commission(which IObbYirig'activity is not prohibited by Code section 2-491) shall disclose such particular service on his/her lobbyist registration form ancfshall;draliV.tliScloSe Such.oarticUlar teNloehefore tobb in.•:thSCI'" Cirtinilieimit.6"Oblidrileatin '. Ye,,4o Have ou: roVided-cam ai n.cOnSultin services, to an incumbent member of the.Cit CortriiiSion, — withimthe,aitetectiono cici7if:'es...please liSttheinctirribent members Ofthe City',Ccirninis-Sion: . . . . ' . . . ; ... _ . „..,. . . . . — : S No: if..es,-were...":leir_.:.:'"ibridietirrorditi.'.'On rec--eiVeecericinde,:aonSideratibni'kexChart'i.fori-cernit n — ",/, ... conii.deS1..: • . . . ,. TOSECOMPLETEO BY CITY-OLeiakSSTAF;F.ONLY . .. . . . , Annual Registration fee: [ ]Yes Vitt No Amount Paid Yt„ .---- MGR# . is.. -gLP__________.Date Paid • Lobbyist Registration Form received and verified by: ' . • 35 . . • FACLERWL1207.004SXL08BYI$1"FORMS\Lobbyist Registration.Pcirrn Revised 03-11,-20 RE,G.dOc ' ,. Revised 03/1112020, - Page 3 of 5 •. • VI. SIGNATURES UNDER OATH: ON.FEBRUARY 28 OF'EACH YEAR, EACH LOBBYIST SHALLSUBMIT'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 TfON'DURINGTHE=REPORTING.PERl0111 , -r /Z-- / IV' Z v e.,.i Signature of Lobbyist: Date. 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 fa ''ar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of the Miami Beach City Code n II reporting requirements. Signature of Lobbyist: �� Date 12 /' / ca Signature of Principal: Date t 2 / 1" J 2.02( VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of. poi':D k State of ROR.,-1 n County of: ' r t ~- County of: M VP V DE; Sworn to(or affirmed)and subscribed before me, Sworn to (or affirmed)and subscribed before me, by means of4 physical presence by means of II§ physical presence or© online notarization, or© online notariz ' n this 14 day of x=(.ice'- = 201, by this I/ day of e-CAPV..2-Rl" 2021 by ' f-OF RIN NAME OF LOBBYIST NAM CIPAL Produced ID. Produced ID FL be_ �-'' . FORM OF IDENTIFICATION FORM OF IDENTIFICATION PC./ ersoially Known Personally Known 9 • MYCOMMISSIONgFIH1004334 ureof Notary Public vi Si nature of N ¢ `' EXPIRES:July 13,2024 _ ,r,ivrto Name of Note , , Name of Notary,Typed, Printed or Stamped (NOTARY SEAL) (NOTA�AFXf JASON SALVATORE i,: ;!,, :, MY COMMISSION U NH 000062 =' -4 -Si- EXPIRES:September 14,2024 The term'lobbyist"specifically excludes the following persons: Bonded Thru Notary Public Underwriters Expert witnessses,who provide only scientific, technical or;other speeialited:information:^or testimony in public meetiimgs,anyperson'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-forprofit community based organization_for the purpose of requesting a.grant%without special compensation or reimbursement for the appearance. Page 4 of 5 /8 B 64,,,,L.,,, r) '‘ I E � 1 ,4{ , i, i 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: . _. ` 1^- ,,,A- ,0 -04-.) 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 pursuant to Section 2-482 of the Miami Beach City Code. 12 iy /0,24 Signature, abbyst Date F:ICLERISALL1aFORMStIOBBYIST FCRMS\Lobbyist Registration Form Revised 03-11-20 REG.doc Page 5 of 5