Ian DeMello, Esq. - Fort Partners, LLC m(Am t/^/ I,C.
RECEIVED
Atv\1AUG 23 2022
tV\I BEACH Office of the City Clerk CITY OF MIA
MI BEACH
1700 Convention Center Drive OFFICE OF THE CITY CLERK
Miami Beach,FL 33139
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 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
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:
Mr. DeMello, Esq. Ian
NAME OF LOBBYIST (Last) (First) (Middle Name)
Shubin & Bass, P.A. 46 SW 1st St. Suite 300 Miami FL 33130
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305 381 6060 idemello@shubinbass.com
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
Mr. Thompson William
NAME OF PRINCIPAL (Last) (First) (Middle Name)
Fort Partners, LLC 500 W Cypress Creek Rd. Suite 770 Fort Lauderdale FL 33309
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305 571 8228 info@fortpartners.com
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
Pursuant to City Code Section 2-482(h)(1)(a) A principal of any corporation,partnership or other entity who appears as a lobbyist on behalf of that
entity,without special compensation or reimbursement for the appearance whether direct,indirect or contingent,to express support of or opposition to
an item shall register with the Clerk as required by the subsection but shall not be required to 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 NIA): William Thompson
• NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST(If none,write NIA): Na
Page 1 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":
Yes VNo: 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 2-490, entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development
Issues":
_Yes v'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?
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 cleric as required by this section,but shall not be required to pay any registration fees.
Yesv/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, 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 VNo: 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 VNo. 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 members)of the City Commission:
Yes VNo: If yes, has it been less than 12 months since the elected officials) whom you provided campaign
consulting services was 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
service before lobbying the City Commission at a public meeting
_Yes VNo-
. 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 VNo: If yes, were you promised or did you receive economic consideration in exchange for campaign
consulting services?
TO BE COMPLETED BY CITY CLERK'S STAFF
)AFF ONLY
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Annual Registration fee: ()0 Yes[ )No Amount Paid$ �' 1 MCR# l . o ]( Date Pahl
D U r z
Lobbyist Registration Form received and verified by: JS
F:‘CLER\SALL\aFORMSkLOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc Revised 03/11/2020
Page 3 of 5
M AMIBEACH
City of Miami Beach, 1700 Convention Center Drive,Miam' 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
NAME OF LOBBYIST: Ian DeMello, Esq.
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.
M/o 02a
Sign ture-orLobbyist Date
F ICLERISALLIaFORMSLLOBBY ST EORMS tctbyisl Registration Form Revised 03 1120 REG doc
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Miscellaneous Cash Receipt
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