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Antwoine McCoy - Miami Takeover LLC VCA-- 6k/11NT "y GEIVElD Av/ \t. I BEACH office of the City Clerk limiAR L6 2022 1700 Convention Center Drive Miami Beach,FL 33139• ITy OF MIAMI BEACH 305.673.7411 6FP(f;E 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;*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 foreseeabiy will be,heard or reviewed by the City 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 sheets)of paper. If you have nothing to report In a particular section, you must write 'none* or "nfa° 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: McCoy Antwoine Jarrnaine NAME OF LOBBYIST (Last). (First) (Middle Name) Miami Takeover LLC '900 Brentwood Road#92578 Washington D•C' 20090' LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 202-350-1270 202-437-2901 antwoine@theniiamitakeoyer.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER- EMAIL ADDRESS II. PRINCIPAL INFORMATION: McCoy Antwoine Jarrnaine -NAME OF PRINCIPAL (twat) (First) -(Middle Name) 'Miami Takeover LLC 900 Brentwood Road#92578 Washington DC 20090 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street)"• '(City) (State) (Zip Code) .954-320-7127 202-437-2901 antwoine@themiamitakeover.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS •u i®@itj@@s13 egga 3 . Ra t cjflG T�,l ad • CY.tL t jti 1r • o s7'end C� 70f11rr9i Tr$71CGllu uCrXt t �rAili r (bQ I tPoiilor !'efios °•d 11QU" ih • T # b ttge+l'VZ.1to Qrfrf -.au"r opal roc° g] teas, if 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): Antwolne McCoy;Vincent Peden,Wylie Kynard • 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): Antwolne McCoy,Vincent Peden,Wylie Kynard Pagel of 5 1 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. 14th.Annual Miami Takeover Weekend Grant-Aopllcation with the Miami Beach Visitors&Convention Authority.(MBVCA) 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.Visitors Convention Authority 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 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 Page 2 of 5 The folio Wing six(6)'que.stiOne MUST be answered; 1 y .Pprsuantto,City Code Sectlori•2488,-.entitled"Prohibited Campaign COntributiOns By Lobbyists•On Procurement IsSuee: Yes No; Are you lobbidini ona present or pending bid for goods,.ertuiorrientor services,or on a ioresent or pending award tor goirdri,-eguipment.or seri/hie? '2) •Pursuant to City Code Section 2490,entiitied'Prohibited:Campaign:Contd4utiont By'Lobbyists Oa Real,Estate Development !sauce: lest)(No: Are you lobliying_on a pending application fora Development Agreement with the City or application for change of zoning map designation_orchange to the Citv'S Filiture Land Use Man? 3), Pursuani to City Code Sectlen 2482(h)„any person (except•those exempt from the definition of lobbylsr as-Set forth In -Section 2481)who only appears as a representative of a not-for-profit.corporation or entity without special compensation or reinturaement for the appearance,whether direct or indirect to express support of or opposition to any item,shaU register with the city clerk as required bythis Section.butshall notba required to pay any registration fees. ,..yes KM): Are Wm representing-a not-far-profit corporation' or entity without spacial •coinpensatienot reimburSemerit7 4) Pursuant to'City Code Section 2-481, the term lobbyist°specifically eicludes 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.eipress 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 XNcc. Are you providing Only scientific, technical or other specialized information; appearing as a representative of a neighborhood.association without spacial compensation or reimbursement or .representing a.nOt-for4irofit based ordanization for thor 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.Sea Section 2-491 for more information. Yes X Mk- Have_vou provided campaign consulting services to an incumbent-Member of the City Commission within the past election cycle?If yes.please ilsithe incumbent member(s)of the City Commissionc • _ - _ _• _ - _ _ _ Yes No :.n (r an ion• s nce se ,cted Otis ails wh;m o e ov..-; m inn s s om . consuithm-U.- 1"--ces wa 6); Pursuant to City Code Section 2482(a)(4)a.,a lobbyist who ties within the past electron 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 Cltv,Cornmission.at a pubic meeting.. _Yes._;.No: Have you provided.dampalan constrifing 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 ' er: o p o ad • d d o ceiv economi c ni•eraTon n a cli a ; meats:in r"STAMIrri=r-veri-i - • TO BE COMPLETED BY CITY CLERK'S STAFF ONLY — — Annuiii,ffOgiritati01611; [ .1Ye-seQ40. Ameiirititeld - _ .14C_ROPf-41 Date Paid __ LobbYist Registration Form,r_acpimo and verified _ _ _ . igediti3/..$1/2620' . Rev Page 3,,of 5 • VL:. 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 ON DURING THE:REPORTING.PERIOD.1' Signature of Lobbyist: Date 'J./9''00 0,0 Ida solemnly swear or affirm'that all of the foregoing recta,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 reporting fequiremerits Signature of Lobbyist: _ Date. j/'y/cQo,2 0 " Signature of Principal: - Date `' // l),QD VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of Lek State of.)ie 1c....l County of: -Pi o,� County oCI)v .0 ' 'Sirvom to(or affirmed)and subscribed before me, •Sworn to(or affirmed)and subscribed'before me, by means of tr7l.physicaf presence by means of r physical presence or CI online notarisation, 'or 0 online notarization, this OA day of i.t i- ,202g,by this.4 day of 'f ra"'at^- _ ,2022,by ` lAt7 ilr� M '. l ^0.0Qi NAME OF.LOBBYIST NAM OF � PRINCIPAL L .Froduced ID vie (_ ne •,,c V,Produced ID—Dr+vO,;..s t,,o_LA44 FORM OF IDENTIFICATION FORM OF IDENTIFICATION _Personate own P rsonall own PT -4%•.i.re • 'otary Public.1 ......NC ••...-CO.,,,, Sig to tary Public !citEr su Nanie of Notary,Typed,Prirlte}f b�1r Wr qt i` Name of Notary,Typed,Printed:or Stamped 42: i •o.0 . .m..b. (NOTARY SEAL) i s 9 9• ‘��� r��. i : ..G I-I G y - `��Q,+'I\ssio /S it, 30 O. 4M © . ',gyp'•%.'rs.20V.0 . 1�,rco I ZZ i 4 - -_,,a,c'`�� : aOTAR y 9sn t , 1 The,term"lobbyist!"specifically excitid �(��i*Tsons: r,,airiiitli 9= A BL G ., Expert witnesses Who provide only scientific,technical or other spec rmaauon,�`$e ny'In public meetings;.any person who only appears as a representative of a neighborhood association wi $rursement for the appearance, whether direct,indirect.or contingent,to ress Support of or o osition�to '9 tr �P PP pP anf 6•s• - . who onlyappears as a representative of not-for:profit community based organization for the.purpose of requestin �P'. . ,�'pecial compensation or reimbursement for the appearance. stsi Page 4 of 5 61,1,NvileiFor <<!v of Miciti(rcyrati,i. eft ,itint _..: Lief 4 paio_i E. .G7(lii11"ck. City CM 3'iy F",'r'• ,�.d ) 3ri'-:VG 7.f�+3' TS1t�✓uCh11+1�ie)Gri NAME OF LOBBYIST: Antwoine'McCoy. 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 30 ''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. .A`r&u119a 2 3/9/2022 Signature of Lobbyist g Date F:tC1ERvALLteoRmstu 9B isT FORMS Lobbyist RegIstratlon Form Revised 03411.20 REG,doc Page 5 of 5