David R. Custin - David R. Cusin & Associates, Inc Tbdtt 4A-t►A1 d3
RECEIVED
.� I _ c { OCT 31 2022
Office of the City Clerk
1700 Convention Center Drive CITY OF MIAMI BEACH
305.673.7411
Miami Beach, 33139 OFFICE 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;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:
Custin David R.
NAME OF LOBBYIST (Last) (First) (Middle Name)
David R. Custin & Associates, Inc.5001 SW 74th Court.,Ste.209 Miami FL 33155
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 607-8576 (305) 607-8576 CustinDR@DavidRCustin.com
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
IL PRINCIPAL INFORMATION:
David R. Custin & Associates, Inc.
NAME OF PRINCIPAL (Last) (First) (Middle Name)
David R. Custin &Associates, Inc., 5001 SW 74th Court., Ste. 209 Miami FL 33155
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 607-8576 (305) 607-8576 CustinDR@DavidRCustin.com
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
P.ursuant o-City Code Section 22-0,82(h)(y))(a): A principal of any corporatian, partnership,or other entity who appears as a lobbyist • behalbrafra
entity,without special compensation or reimbursement for the appearance,whether direct,indirect,or contingent,to ex•resssu•••rt of• ,o•••sition
an item shall register,witfi the Clerkkas required,bytthis subsection;but,shall not,be required to pay any registratian,fees
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided
pursuant to City Code Section 2-482(0
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write N/A): David R. Custin, President
e 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): David R. Custin, President
Page 1 of 5
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.
All matters/items regarding the renewal of the City police & parking department towing permits.
Any matters/items relating to 2022 ballot referendums 1, 4, 5, and/or 6.
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
City Manager, administration staff, &City Attorney's office None IJ El
Mayor and all other Members of the City Commission None LI VI
Commissioner Alex Fernandez Political campaign consulting services if I
Commissioner Kristen Rosen Gonzalez Political campaign consulting services 1
r--
Fl-
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):
None
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):
$1,000 per month allocation from monthly salary for this project.
Page 2 of 5
I
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":
ElYesr lo: 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":
[JYesJ Jo: 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
e city clerk as required by this section,but shall not be required to pay any registration fees.
Ely- •Q o: 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
-imbursement for the appearance.
es L'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
following the swearing in of any elected official(s)for whom the campaign consultant provided campaign consulting services
within thepast election cycle.See Section 2-491 for more information.
I✓ Ye!—INo: 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:
Provided political consulting services to Commissioners Fernandez& Rosen Gonzalez.
1=1YesLNo: (f yes;,has°It tieen�aless thans 12'months since;the'electe Lafficiial(s)rwh'om toui provrded'camtra�grn
consulting serurceswas'.Jsworn 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
R
l rvice before lobbying the City Commission at a public meeting.
Ye4JNo: 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:
• Commissioners A. Fernandez & K. Rosen Gonzalez.
all:1 : If
yeStrlti q g �up�mised or_did You receive_economic;consideration iin exchange:for campai�tni
Yes, of course. I don't work for free. It's my livelihood.
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: ( )Yes No Amount Paid$ # t Y
Nift ct l (f
Q(9 Date Paid
Lobbyist Registration Form received- ."- MCR
and verified by: ,...15
,c ..... _ ., .;L,s._ .y y. 11. F _..c,,.,,. r..:'>,.h . - .F ir):-F,C,.ii=tc. Revised 03/11/2020
Page 3 of 5
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 . OBBY. A STATEM NT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR CO i, ' •N D; T ' PO; ING PgRlOD 1
Oil'
/
Signature of Lobbyist �4 Date f o ./ 3//Z d 2.2-
1 %
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 a .miliar 'r 1 , - •r•vision •ntain-_ '- Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
the Miami Beach City Co• - an$ • ..'ortin ,, uir- e ii i,
Signature of Lobbyist 1 1/ Date / D1 / /70 Z 2-_
Signature of Principal: 11012P I Date / tJ/'.f/ / ? 2 a
Amp-41.- r —Ar r
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
•State of f,Un�G State of U vid
County of: t Gnt \i -iX -- County of:n IG►'Y\1 -(xc
Sworn to(or affirmed)and subscribed before me, Sworn to(or affirmed)and subscribed before me,
by means of El-Krsical presence by means ofE physical presence
or 0 online notarizatio, or 0 online notarization,
this '3I day of ur tues b .20a-1;by this S i day of CC D1)6," ,20 by
'VA id C Sk-1 n +00\vlci M1-i r
NAME OFLOBBYIST NAME
��OF'PRINCIPAL
✓Produced IDC 5`f(4'' bC.4°2'0 Produced ID C755' 11(:)'Cc:$9 'U0 'v
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
_Per. •nally nown _P sonally Known
I
SI.'' re ;Notary Public r Notary Public
SorOt1 Air inn 1, i v(4 41/4/On i D
Name of Notary,Typed, Printed or Stamped Name of Notary,Typed,'Printed or Stamped
( S
NOTARY Notaryandra D Public A Statrmie jo of Florida ' (NOTARY6EAl) Notary Public State of Florida
My Commission 1ilIL Sandra D Armijo
'i•"1111' HH 236205 ) 1 1111 My C 36205 2 on i
Exp. 3/3/2026 1 1 Ex 3/312026
I 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.
Page 4 of 5
•
1\--A„:_,:,iirAm.:,. .r.„14,
14yof Beach,1.7Q0'C9nventron Center DiiverMicmi Beack F19nda 33139:wWw,mipmibec1. l g9vr
C30ce of the City Clerk
Rafael E Granodot City Clerk' Cif yClerk@mtamibeo hfl gov
Tel;305: 73 741'l, Fax 305 6734
NAME OF LOBBYIST: David R. Custir
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 $50.00 a day shall be assessed for Statements filed after the
due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and
Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the
assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30th of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
I hereby acknowledge that on February 28 of each year, I shall submit to the City Clerk a
signed Statement under oath listing all lobbyist expenditures, as well as compensation
received, for the preceding calendar year with regard to the specific issue on which I have
been engaged to lobby.
2) LOBBYIST WITHDRAWAL
Once an issue I have registered to lobby has concluded or I am no longer lobbying on
that issue, I shall immediately file a Notice of Withdrawal with the Office of the City Clerk.
3) ANNUAL LOBBYIST REGISTRATION FEE
I understand annual registration of all lobbyists shall be required for each 12-month period
commen •• October 1 of each year, and the fee for such annual registration shall be
I +-• pu . nt to ion -482 of the Miami Beach City Code.
10/31/2022
Signature of Lobbyist Dale
F:ICLER4$ALL1aFORMSILOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doC
Page 5 of 5