2024 Lobbyist Registration Form - Fountainebleau Development (Daniel Adkins) DxuSi�n EnvNope ID�.B4AiFE00.]656-0812-A7FC-3ABOB2DOCASE �d U R��O�iU/G Q V
Da.rak�( ment
� � ' ' Offce of the Ciry Clerk
1700 Convention Center�rive + �� � - � �
Miami Beach, FL 33139
305.673J471 - .
LOBBYIST REGISTRATION PORM � � � �
Lo�byist means eli persons employetl or retaineQ whether paiU or not, �y a pnncipe�who seeks to encourage�Oe passa�e, deteet or
modification of any ordinance, resdution, apion or deGsion of any commissioner. any aclion, tlecision, recommendation of Ihe Ciry
Manager or eny Ciry board a commi�tee;or any action.tlecisbn or rcrnmmendation of eny City personnel dunn9 the time penod of lhe
entire deciaon-making prxess on such action, decision or rewmmendation that toreseeably wtll be heard or reviewed by the Cily
Commission, or a City board or commidee. The lerm specificaily includes the pnncipel as well as any employee engeged in lobbying
activities. The tertn "Lobbyaf has speafic eaGusions. Please refer to Giry Gotle Chapier 2, ANcle VIi, �ivisbn 3, enfi9etl'Lobbyists.'
for aGOitional informaVon.
Instruc[iore: Piease comple[e all seclons of this(oem a�M submit ihe completetl fwm,with the applicabie fee,to the Off�ce of the City
Clerk. If you need more spece to wmplete an answer, use a separete sheet(s)of paper. If you have �w�hing to report in a partcular
section, you must write 'none' or 'n/a" in that section. Any charge ro any information onginally filed. or any edditionai Cdy
Commissioner or personnel who are alw sought ro be bbbied shell require that the bbbyist file an amendmen�Io Ne registration fortn.
The lobbyisl has a continuing duty lo supply informatbn end amend the fwms filed throughou[ �he penod �hat ttie bbbying occurs.
Separa[e registrelion f«ms shall be required for each prindpal represmted on each specific issue.
t. LOBBYIST INFORMATION:
Carmona, Jacqui
NAMEOFLOPBVIST (LasQ (Firsp (�vfidtlleName�
401 E Las Olas Blvd, Suite 13�-047, Fort Lauderdale, FL 33301
LOBBVISTBU5ME55NPMEANDADORESS (Num�erantl5treeQ (CRy) �State) (ZlpCoae)
305-283-4558 jacqui@rubinturnbull.com
LORBVISTBl151NE55TELEPHONENUMBER GELWtARTELEPHONENUMBER EMAILAODftE55
II. PRINCIPAL INFORMATION:
Adkins, Daniel
NAMEOFPRINCIPAL (Last) (Firsp (MiQ0leName)
PONTAWEBLEAUDEVELOPMENT 19950WESTCOUNTRYCLUBDRIVE, tOhIFLOOR.AVENTUR4, FLORIDA33180
PRINCIPALBUSINESSNAMEANDADORESS (NisnberardSbeeQ (CRy) (Slate) �ZipCotle7
(954) 924-3123 dadkins@tbdev.com
PRINCIPALBUSMESSTELEPHONENUMBER CELLVLARTEIEPHONENUMBER EMAILADORESS
Pwwarrt lo CttY CaEe Sertim Y�G1l�XiNa1:�A R�a1�.enY�aUan..P��'M.-or W�er arititY N�eVOebs aa�e IaObY��an beliel!M�thnt
mH�Y,wilirou[epxle�cortpeBatlon a roYiiEusemen[fa�Ne eppeaiaMa;wMMm Gkxt B�Ovxt a tanOnWM.lo e*P��S s�P�al a qpmtlbn W
en ilem shel�agister wk�Ne Cbtk es reWieU tY ttYc s�seclbn EutsNG rW Oe�¢9��b�OaY�Y�tratlon fees�.
If the principal is a Corporation, Partnership or Trust, the following Information MU T be provlded
pursuant to City Cotle Section 2-082(c):
Daniel K. Adkins
. NAME OP CHIEF OFFICER,PAR7NER,OR BENEFICIARY(if fwne,write!llA):
. NAME OF ALL PERSONS HOLDING,PIRECTIY OR M�IRECTLV,A SY.OR MORE OWNERSHIP IN7ERE5T IN SUCH
CORPORATION,PARTNERSHIP OR 7RUST('rf�ane,write N/A�:
Daniel K.adkins
Page 1 ot 5 �
��
DcwcSgn Envebpe N�BGA]FE00.'650-9B12-AiPF3A80B2CaCA5E
Itl. ISSUE TO BE LOBBIED:
DescNbe with as much detail ss is practical, inclutling but not Iimitetl to a specific Aescription where
applicable of a pending request for proposal, invitation to bid, or public hearing number.
Founxainebleau developmenx in wiami Beach
IV. CITY AGENCIESIINDIYIDUALS 7Q BE LOBBIED:
PursuaM to Ciry Cotle Section 2-482(a)(4�, Iist the City Commissloner or City personnel sought to be
lobbied, and whether the lobbyist has errtered IMo any contrectual relationship (paftl or unpaid) with
said City Commissioner or CHy personnel from 72 monihs preceding sucA commenceme�t of service
with the City to the present data,stating the generol nature of the suhJect corrtractual relationship.
Full Name of Individual and Contractual Relationship (If yes,explain) VES No
THIe of Person to be LobbiM
Mayor, Commissioners, and City Staff X
_—_. —
. . . ___i_. ._ I.._ _._I
Pursuarrt to City Code Sectlon 2-482(g), every regisVant shall be requfred to state the e�Rent of any
business, flnancial, tamilial or proTesslonai relationshfp, or other relationship gfving rise to an
appearance of an impropneiy, with any curteni Ciry Commissfoner or �i"ry personnei who is saugni io
be lobbtetl as identlfled on the Iobbyist registrotion torm Hled.
List any Buslness, FlnancWl, Famllial or Professional Relatlonship, or other relatlonship giving rise to an
a arence of Im ro rie If none wrtte!UA :
N/A
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Soeci£c. (Note that a
contingency fee is prohibited pursuant to City Code Sec. 2�485.3):
Page 2 ot 5
�oca5gn Emelope 10:64A]FE00-�650.4812-A]FCJA808200CASE
The foliowing six(6)questions MU57 be answered:
t� Pursuant to City Code Section 2d88,entitletl"Prohibiled Campaign ContnWtions By Lobtryisis On Pmcu2meoi Issues"'
_Yes_No: qre you lobbvina on a oresent �oenAina bitl for aoods eauiommt a urvices or on a orecent r
cendino awarC for aoods.equiumerrt or xrviceT
2) Pureuant to Gity Code SecUon 2d90, enfitleC'Prohibifed Campaign Gonttlbu6ons By Lo6byisis On Real Estare Devebpment
Issues''
_Yes_No: Are vou b66vina o a oeMino aodicatio�tw a Develownent Aareemant with tM CiN w aonlieaTon
f cha eotzonin me des' a 'o r han theC' ' n UaeM 7
3) Pursuant to Ctty Code Section 2-A82(h�, any person (eaccept Uose exempt hom ihe definitan o�'IobbyisP as set foM in
Section 2-081)who only appears as e representative of a no4forvprofi�corporation or entdy wdhout special mmpensation or
reimbursement(or lhe appearance,whether direct or indirect to express support ot or opposition to eny item,shall re9ister with
ihe cHy clerk as required by ihis section,but shall rrot be requiretl to pey any registralion fees.
_Yes�lo: A r Gn a t f fit ti titv kMut ' 1 co eti r
relmbursemmt9
4) Pursuant to City Code Section 2481, the teim "IobbyisP apeciticalty exGudes the fdlowing persons Ezpert witnesses who
provide onN scieMific, lechnical or other spedalized infortnation or testimony in pubiic meetirgs;any person who anly eppears
es a representative of a neighborhood associetion vdthoW compensetion or reimbursemenf for the appearance,whether diretl,
indirecl or con[irgent,[o eryress support of or oppositbn to any item;and any person who oniy appears as a representative of
nobfor-proft crommunity Eased organization for ihe puryose of requesting a grant wRhout special compensation or
reimbursement for Ne appeerance.
_Ves4LfJo: A iE" pHy sc' tifi techn' I w ther iai'netl ' formatiq�� as
reonsentaWe of a ne' hborhwE auociat'on 'tlwut soerial com naad reimbursemerrt r
reprexMina a notJor-oroHt baeed oraanintion for Me ouroose of reouestino a arant wkhout
soecial mmoemation or reim6ursemenY7
5) Pursuant to Ciry Code Seclion 2d91(1), rw campaign wnsultent shall lobby We Cily Cwnmission for a penod of 72 months
following the sweenng in of eny elected o�fiqel(s)for wfrom lhe campaign consultent providetl campaign corisul6rg services
w�hin[he past Neclion cyde. See Sedion 2d91 for mme information.
_Yes�No: Have vou arovided wmoaian consWtino services to an incumbem member of the Cilv Commission
wilhin the oaat ekction wGe41f ves.olease list Me incumbent membertsl of the Citv Commission•
_Yesu{10 M Yea.�h�a k been.leaa tlw� t2 menlhe ti�e iM�eMcfM e/MiaYcl M�em veu e��wMM ri�nn�iwn
mnaWtlna�aarvices wu swam in?
fi) Pursuent to Ciry Code Section 2d82�aJ(a)a., a bbbyist who has within Ne pest election cyGe provitletl rampeign consulting
services to an incumbent rt�.vnber of llie Ciry Commission (which lobbying ectivity is not otherwise pmhibited by Code section
2-491) shall disclose such particular service o� his/her lo�bykt registration fortn and Shell ueNv disdose such oerticuler
e ' r I 1 Fc m
_Yes Ma: Have vou orovitleA ramoapn consulri�w cervius ro an incumDant member of 1M C'N Comm"scian
r within tha oast ekclion cvUe9 H ves.oleaae list Me ineumben!membsAcl of tha CiN Commiwion:
_Yes�lo: M vas� yars vou nmtttNed or�Nd vou reaNe ecanaNc contMe�ion ki.ucfwnw lor cmroalan
conaWHm sarvias9
TO BE COMPLETED BY GTY CLEftK'S STIIFF ONLY G
MnualRepiatratlonfee: l�lYecl 1�No AmouMPaiG /i�t.O(7. IACR♦ � d DaroPaltl� O �
lobbyial Rnyb4atien Farm recNveA a,W vMlfed by:�M
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C�� �.iev.l ) ssues �700•"',
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VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR EACH LOBBYIST SHALI SUBMIT TO THE OPFICE OF TME CITY CLERK A
SIGNED STATEMENT UNDER OATH LIS7ING LOBBYING EXPENDINRES. AS WELL AS COMPENSATION
RECENED. FOR THE PR�CEDiNG CAI.ENDAR YEAR WI1N REGAR� TO THE SPECIFlC iSSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN �F THERE HAS BEEN NO
EXPENDITURE OR COMPENSATION DURING 7HE REPORTING PERIOD.'
SignatureofLobbyist ^'- '��-:�� L. . Date 3�8���z4
I do solemnly swear or affirm that all of the faegoing iacis, statemeNs, and disGosures in this form are We and correct,
antl thaf I have read or am familiar with the provisions contained in Chapter 2. AR. VII, Division 3, entitled "lobbyists" of
[he Miami Beach Ciry Cotle and all�eporting�equirements.
�-`- 3/8/2020.
Signature of Lobbyist: '- ���<'"�'. ..--- Date
Signa[ureofPrincipal: pq� j�( Q��jk,S _ Date_3���2e'4_ _
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPA�
State of Florida State of Florida
county of: BfO'Nab Counry oC Broward
Swom to(or aKrmetl)and sub=_cribed betore me, Swom to(or affrmetl)and subscribed before me,
by means of�physical presence by means of O physical presence
or�online notanzation, or B online notar¢atbn,
.� =do�CS ua..��, n_�C f I uii'o 1'vuy G •'•'a:C �� �y
Jac^": Ca:mona Csn'�I Adkir
y�,
NPME OF I.OBBYIST � NPME OG PRMCiPA�
ProducedlD ProducedlD
FORM OF I�E HTION FOfiM OF IOENTIFICATION
�PQ�sonally Knywn �� X Pe�nally KnoWn _
�/K//nM�.y I//,)� �� ��'� / l
li�� w-/="�""�' ' �
Signature ot Notary Public Sig a ur�ubli
��vricYa t�r�altiht�lacic�� �'lLlronc� l�r��h��IcAC �de-
Name of Notary,Typed, inted w Stamped Name of No�ary,Typed, Pri ed or Stamped
(NOTARY SEAL) "+"�ShafOntla WfIpM-PlaCide NOTARY SEAL) �•;{,-�s $�ppitle WfqAPPyc1Ue
�°`-...... Cartm.:HH 378987 �
;.'�� � Fxpires:March 27.2027 �� `�€ Comm.:HX J7B9D1
�"�` Nohry Pu06c�State ot FlaiUa �,.�y�„j���s:Ma�CA 7I,2027
�.,,,��,.,,
'Theterm'IobbyisYspecificeityexGudeslhefdlavin9pereons: "°",,,,°° NoleryWbfC�SWBOtPbAGB
Expert wit�sses who provide only scienlific,technicel or olher special¢ed informafon or testimony in pu�ic meetings;any person who
onty appears as a reD��nWtive of a rieighborhood association wdhout compensa6on or reimbursement for ihe eppeerence, whether
direct, indireci or contirgen(to express support af or oppobition to any item; end any person who only appeare es e representative of
not-far-profit communiry based organizefion for the purpose of requesUng a grant without spedal canpensation or reimbursemenl for
�he eppee�ence.
Page 4 of 5
�ocuSignEnveWpelD'89A�FEOD-7656-0812-A7FC3ABOB2DQGASE
City oF Miomi Baaah, ll00 Conrenfion Cemer IDivc, Mfar..�B"w.h, Plor�co?ii39,h+wi.��.lomi6cachfl-go-,
OfFce of ihe Clly Clerk
RoFoef E Gmnudq Ciry Cle�k CityClerk@micmibeochH gov
Tel-305.673 7411, F�x_305.b73 7254
NAME OF LOBBYIST: �acqui Carmona
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 penafties that may be imposed as provided in
Section 2-485.1, a fine of $50.00 a day shal� be assessed for Statements fited after the
due date. The City Clerk shal� 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 [he
assessed fines aker notification.
Any lobbyist, who fails to file the required Statement by April 30U of each year, shall be
automatically suspended from lobbying until alI 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 Ihe preceding calendar year wi[h 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 1 am no longer lobbying on
tha[ issue, I shall immetliately ftle a Notice of Wlthdrawal with the Once of the City Cterk.
3) ANNUAL LOBBYIST REGISTRATION FEE
I u�derstand annual registration of all lobbyists shall be required for each 12-monih period
commenci�g Oc[ober 1 of each year, and the fee for such annual registration shall be
$500.00 pursuan[to Section 2-482 of the Miami Beach City Code.
�`-.
;�2 _.. 3Js/zoza
Signature of Lobbyist Date
i��CLER.GLILFORM5LL066V�STiCRMSV.tlANaillepYew�Fom�RevlavC OJ�fi-APEC W.
Page 5 of 5
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