Lori Faye Bakkum - Ryan David New Ml A/ kl �BEACH -Office of the:City.Clerk
1700 Convention.Center Drive :1:N 2 6CEI 2023
Miami Beach, FL 33139
'305'673.7411 City OF fl�I'4M:�EAC[-�
LOBBYIST REGISTRATION FORM OFFICE OF THE CITY CLERK
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;Dr 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:
NAME OF LOBBYIST (Last) (First) (Middle Nan e)
:FL P6 T31
he iCot_ta mic IC We �" moilk, i:4
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) - (City) (State) (Zip Code)
39S- .?, - 63'eS LrQ,R-Kmir Ca.- ki„.,,),(01,
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADD ESS
II. PRINCIPAL INFORMATION:
`i vi
NAME OF PRINCIPAL (Last) (First) - (Middle Name)
)
3139
Pc)LA)e< •
PccPcc. Inc kt oy( mtc' -ic,Pr : *t;P yv wit,t,u ce p F
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
.9(01- —70 R1) L. g0AV110N eL0. eAIai( , cam;
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL_" DDRESS
urs In Sectiom2-482 1 (a m' { .,, )( p. A"prin pal any rporat on,partnership;or;other entity who ... 0f5lobbyist 01ll t hat
entity,without>special compensation or+reimburserrnent fort e appears ce,wi ether direct,indirect,rrp contingenrress�support_of_or�oppositio_to
Zitto -shall.registerr<w,t7Lthe Clerk"(as'.ieyuiradibyxthissubsectionlbuC ha I,natbe�requt edito,pay any"regis .tion 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 N/A): KS.1 C(r /a v i° Ne-Cu
• NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION,PARTNERSHIP OR TRUST(if none,write NIA): :PLit,r atvt r) n .:A..3,
Page 1 of 5
M. 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.
1 Ex
_Cr e(Af Spot. /pS
__Vi►q-to L 9c vto:r re-ArGn
UU &)cam, =c le. S a irk Cwl+U22 ¶ 1 (C
Pc4DVDC Pra.1 prO (x
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
pici�c-I-oQ v F
DSc a-p e A i(o S t n ", -r► .� <u�rg 2E r "St-4 4
a,Aa1. cul-{-ire A=c <s _, s4-4f.
per iiack v-+ M
('}r' QJA1 .06E13er i O Mv\I'cI osaces_1 1/ giC HA1eV cx "., X
r.perci�l cr,o22ALezv srepfick, wve7ue1j [- -(i pcLY 1oc..4 X
iK:x, FectuAtuotZ.,
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 NIA):
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):
- 'O1
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Tlief011OWthg•ahr,(6yOtietiSOne MUST'beartsWereali: • .
1) Pursuant faCityCOdeSectiOn2;488,,entitleeFrohibiteriCampaign)CantrithitioneSytobbljatSOnPrecurernent littruerr:::
.. .
_,Yes&I• ie A"re you lo bbviria on a present or pendina bid far goods..equipment orservices,.or on as present or
' pending award for000dm.equipment or service?!
2) Pursuant to City-C'otie Section4490,,,entitled"ProhibitediCarnpaign Centribtitionsay,Lobbyists Oh Reali Estate.Development
issue ";
. . .
Yesr)&10:',. •Are Vou lObb4ing on a oendingertoliCation fora'DevelonmentAnreement With the Cite or abOlication
_ .
IOC chants Of zonina map designation-archangel:a the Mira Future Land Use:Mao?
, .
ay Pursuant tri...City Code 'Sedan 2.482(h),.any person(except those exempt from the definition of llObbyiar as-set forth in
. " Section 2-481)who appears as a rePn4sentatiVe of-a-not-fariprofit corpor,ation Or entity Without special compensation Or
- reimbursement for the direct or indirect to express support of or opposition to any item.thalf register wfth
the city clerk as required by-this sectiOn,but shall not be required to;pay any registration fee*.
•
• ) Yes._NCC.' . - Are vett representing a not-for-profit corporation,,or eritihr-WithOnt special compensations or
• • • reimbursement? - .
. • . • -
•
4y- .fursuantird City CodeSectiOn.2481,.the,term lobbYide.SpeCifiCally excludes-the follOWIng persons:Evert!Amasses whO
' provide only scientific,.technical or other specialized informatiPrr or testimony impublioineetings;any person who only appears
as a representative of a neighborhood association Wood compensation or reimbursement for the appearance,.Whetherdirect, •
-indirect or contingent,to express support of oroppositiontgany itenr arid any only appears as a representative of
• , . not-for-profit community based organization for the purpose of requesting a grant: without special•compensation;or
. ,reirnburoement.fOr the appearance.-
Are'vou providing OW stientific,. technical or Other specialized infOmtation: appearing as a
. . ' -• ' representative Of a neighborhood association without:special compensation or reimbursement or
• I
• . reon3senting a not-far-profit based Organization for. the purpose •of requesting a grant without
. ' softiei compensation or reimbursement? '
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5)- - .' Pursuant to City Code Section1.-491(I),no campaign consultant shall lobby the City-Commission for a.period of 12.niontha
, following the swearing in of any elected official(s)-for whom the campaign consultant provided campaign consulting services • •
• - . • within the pad efection.ckcie,See%Coon 2491 formore.infooriation_
VesAkto: . Have you provided campaign consulting services to an incumbent member of the City.Commission
withinthe past election cycle?-lf ves„alease list the incumbent meMberisl of the City Commission:
. . .
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' ..,Yee_No: - If.Ves, has it been less than 12 months since the elected official(s)Whom you provided campaign •
consulting services Was.-swOrn in? •
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6) Pr UrSuant to City Code Section 2-4132(a)(4)a.-,a lobbyist WhOhasWithin the-patt election cycle provided campaign consulting
services to an incumbent member of the City Commission(which lobbying activity is not otherwise prohibited by Code section
• 24E41) shill disclose such particular service on hislher lobbyist- registration form and shall orally disclose such particular
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service before lobbying the City Commission at a public meeting. .
Yes YIWO: Have you Provided campaign consulting services tO an incumbent member of the City Commission
within the past election cycle?lives.please list the Incumbent member(S),of the City Commission:
. •
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_Yes No: lives.were you pronileed or'did you receive economic consideration in exchange for campaign
consulting services? .
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TO BE COMPLETED BY CITY CLERK'S STAFF ONLY .
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Annual Registration fee: r. ]Yes f' I No. Amount Paid$: MCR M. Date Paid
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Lobbyist Registration Form received and verified by: ' . • •
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FACLERI$ALL‘aFORMS‘LOBBY/ST FORMS klobbyist.Registration Form Revised 0341-20 REG.doc . Revised 03/11/2020
' Page..a.Of 5 - •
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- SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF'EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERIC A
SIGNED STATEMENT' UNDER OATH. LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATION
RECEIVED. FOR THE:PRECEDING'CALENDAR YEAWINITH 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 COMPENSA N DURING REPORTING PERIODJ
_
Signature of Lobbyist u Date fr
I do solemnly swear or affirm that ail of the foregoing facts,statements,:and disclosures in this form are true and correCt,
and that I have read or am familiarwith,the provisions contained in Chapterl,Art Vit Division 3.entitled'Lobbyists*of
the Miami Beach City Code and all orting requirements
•
Signature of Lobbyist • ,,,„11.- 0 Date it ir11-.2
Signature of Principal: t 441- ,' • Date i02/2 Z •
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST; - 'PRINCIPAL,
j"--
State of r turitin _ State of tL
Cotirti Of DCA de efil(ri' in /7-1
County of: , _I
Sworn to(or affirmed)and subscribed before me, Sworn to(oraffirmed)and subscribed before me,
by means tif, Ohysical presence by means otaphysical presence
or CI orOine notanza _ or1:1,9nline notarization, ,
this clay of MOVe.G1 167— 20gby thisday of 7)ale) 2(122_,py
F"' yC P'at(.11-410/ A)AX9f).
NAME OF LOBBYIST NAME 0qPRINCIPAL
xforoduoed ID Ph 1)1, ProduCed ID ../ 7-7.0cC-2)
FO OFIDENT1FICATION FORM OF IDENTIFICATION
PersOn 1<ti Personally Knowni?
• '-••••"0( mw-
Sina Notary Public • Signature of Notary Public
• ci F /a t o 11 triel4110
Name of Notary,Typed, Iiinted or Stamp&l Name of Notary,Typed,Printed or Stamped
(NAjetY,SEAL) .„ - (NOTARY SEAL) 4e.7.s. mos lova
49'..•••Z ' GARY • , =** Comrnissik.101258330
*
231811 3+4 oF n.0 api183 OdaberS,2225
• .
The terfri ' • '' tides the following persons:
aped witnes... who provide only scientific,technical Or other specialized information or testimony in pubic meetings;any person who
only appea 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 representafive of
ar
not-forLprofit community based organization for the purpose of requesting a grant wittiout special compensation or reimbursement
the appearance.
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MIAMI BEACH
CBI,cA Miami Beach,1700 Convention Center Drive,Miami Bead',Florida 3313%www.miantibeachR.gov
Office of the City Clerk
Rafael E.Gronado,City Clerk CityClerk@miarnibeachflgov
Tel:305,673.7411, Fax:305.673.7254
NAME OF LOBBYIST:
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 iminediately 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.
Signature.of Lobbyist Date
FACLEFMALLtaFORMSIOBEWIST FORMStabbyhd Riegtstrellon Form Revised 03-11-20 Rp3 dm
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