2024 Lobbyist Registration Form - Installation of Digital Signs (Adam Borchers) ��( rta+al1a-}to<n
DocuSign Envelope ID�.FOBDA339-AFSD-4]36-AfiGF-B801B356GC3F f7'i ���� ��\ �/�9n�
'.0 [ ,;. �.V- 1J
, . , , , � �� �j r' �-� ,
' �- ' � OffceaftheCltyGlerk i��� x� L1114
1700 Convention Center Drive
Miami Beach, FL33139 � .. . �.)i� P,91q`dl F?�ACH
3�5.6737411 . � . .
LOBBYIST ftEGISTRATION FORM
Lobbyist means all persans employetl or retaineQ whe�her paitl or not, by a pnncipal who seeks to encourage�he passage, tlefea� or
motlifiwtion of any ordinance, resolulion, aIXion or tlecision of any cammissioner any aMion, decisioq recommentlation of Ihe Qry
Manager or any City board or committee�, or any action, tlecision or recommendation of any City personnel tluring ihe time periatl of ihe
entire tlecision-making process on such ac[ion, decision or recommentlation that (oreseeably will be heaM or reviewetl by the City
commission, or a City boaN or committee. The tertn specifcally includes ihe principal as well as any employee engaged in lobbying
ac[ivilies The term"Lobbyisis" has specific enclusions. Please refer to Ciry Cotle Chapter 2, ArtiGe VII, Division 3, entitletl "Lobbyists,'
for additional information.
Instmclions: Please complete all sections of this fortn antl submit Ihe completed fortn,with ihe applicable fee, to ihe OKce of the Ciry
Clerk. I/you neetl more space lo complete an ansvrer, use a separete sheet(s) ot paper. If you have nothing ro report in a particular
sectioq you must write "none" or "n/a" in �hat section. Any change to any information onginalty filetl. or any additianal City
Commissioner or pe5onnel who are also soughl lo be lobbietl shall require that the lobbyist file an amendment to the registrdtion (orm.
The lobbyist has a continuing duN to supply information and amend ihe forms filed throughoW t�e periotl that the lobbying occurs.
Separate registration fortns shall be requiretl For eac� pnncipal represented on each specific issue.
I. LOBBYIST INFORMATION:
Lanc William
NAME OF LOBBVIST (Lesl) (FirsQ (Mlddle Name)
Ike Smart City, LLC 250 North Hartford Avenue Columbus Ohio 43222
LOBBVIST6USWESSNHMEANDADDRE55 (Num�erantl5ireeq (Clly) (S�ate) (ZipCoaeJ
�sos� z9y-6y�� � I oine @w�llir�mlav�e .cpm
LOBBVISTBUSMESSTELEPHONENUMBER CELWLARTELEPHONENUMBER EMAILAD�RE55
11. PRINCIPAL INFORMATION:
Borchers Adam
NAME OF PRINCIPAL (Last) (First) (Mit101a Nama)
Ike Smaxt City, LLC 2a0 Narth Hartfocd Avc�uc Columbus Ohio 43222
PRINCIPAL BUSW ESS NAME ANO HDDRESS (Number antl SUeep (Clly) (Sta�e) (Zip CodeJ
(3051299-6977 developmen[C obm.mm
PRINCIPALBUSINESSTELEPHONENUMBER CELWLARTELEPHONENUMBER EMAILAD�RESS
Pursuanl to City Catle Sec[ion 2>82(h)�i��a)�. A principal of any corpora�ion, patlnership, or o�M1er entity w�o appears as a lobbyis�on bebalf of Nal
enlily.wi(hoW special wmpensa�ion o��eimbureement b���e appearance.wM1e�M1er tli�ect inCi�ect,o�conlingen�,to express support ot o�opposi�lon lo
� an Ilem shall register wit�I�e Cleik as iequiretl by iM1is su0setlion but sM1all not�e required to pay any re9�sValion fees.
� r
� If the principal is a Corporation, Partnership or Trust, the following information MUST be provided
� pursuant to City Code Section 2-082�c�:
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARV(if none,write N/A�: Atlam Bomhers
� NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLV,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
I � • CORPORATION,PARTNERSHIP OR TRUST(i�none,write NIA�: See a��ached
. Page 1 of 5 �
�3 {ryry�y�''��
� D u v� � . ��a�n F xrvi.iµi Page oib t6�6BPC<EEOBE ����� �-�n������
DocuSign EnvelaoelD:fOBDA339-AFSD-4l36-A6CF-8801B3564C3F
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.
Development Approvals & Permitting Issues,including but not limited to the Historic Prescrvation
Board, Design Review Board, Planning Board, Board of Adjustment, Land Use Development,City
Commission, and any City Workshops or Commit[ecs, if necessary, relating to the installation of
digital signs in vaiious locatio�s in Miami Beach, Florida.
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 Contrectual Relationship(If yes,explain) YES NO
Title of Person to he Lobbietl
Staff for the Planning& Building Department Nonc X
Public Works & City Administration, PB,HPB, BO Vone X
DRB, Ciry Commission,and Mayor as necessary None X
Land Use &Sustainabili Committee None X
Pursuant to City Code Section 2d82(g�, every registrant shalt be required to state the extent of any
business, financial, familial or professional relationship, or other relationship givinq 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 registrotion form filed.
- List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an
- a earance o(im ro rie if none,write N/A :
�� None
_ V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note tha[ a
- contingency fee is prohibited pursuant to City Code Sec. 2d85.3):
Szso/n�.
3 Page 2 of 5
� cF�s��A a�Eac�od� aaaeoo,e ,Decaeeaeeoee ����k��-,�������
' DocuSign Envelope ID'.PoBDA339-AF5�-0]36-A6CF-8801B3564C3F
The following six(6)queslions MUST be answered:
1) Pursuant to City Cotle Sectian 2<88,emitletl'Prohibi�etl Campaign Conlributions By Lobbyisls On Pmwrement Issues"�.
Ves zNo: Are vou lobbvina on a oresent or oendinu bid for aoods. eauiomenl or services. or on a oresent or
oendina award tor uaods.eauioment or service?
2) Pursuant to Ciry Code Section 2d90, entitletl "Prohibitetl Campaign Goniributions By Lobbyists On Real Estate Developmen[
Issues"'
Ves x No: Are vou lobbvina on a oentlina aoalication for a Develooment Aqreement with the Citv or aoolica[ion
(or chanae of zonina mao tlesiqnation or chanoe to the CiN's Future Lantl llse Mao?
3) Pursuant to City Code Sedion 2d82�h�, any person (except [hose exempt fmm the definitian of "IabbyisY' as set forth in
Section 2-481)who onty appears as a representa�ive of a no4for-pmfi�corporation or entity without special wmpensafion or
reimbursemen�for the appearance.whether tlirec�or indirecl�o express suppart of ar apposition�o any item,shall register with
�he ciry clerk as required by�his section, bW shall not be requiretl ta pay any regisiration fees.
Yes xNo: Are you representinu a noF(or-orofit coroo2tion or entih without sueeial comoensation or
reimbumement?
4) Pursuant to City Cotle Section 2d8�, the term "lobbyisf' speciticalty exclutles ihe Pollowing persons�. Expert witnesses who
provitle onry scientifc,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 Por ihe appearance,whether Girecl,
intlirect or conlingent,lo express support o(or opposition ro any item�, antl any pereon who only appears as a representative of
nat-for-pmfit communi�y basetl organization for the purpose o! requesling a gran� without special compensation or
reimbursement for ihe appearence.
YesXNa: Are vou omvidinu onlv scienli�ia technical or ol�er soecializetl infortnalion: aooearina as a
reoresenUtive of a neiohEorhootl association without soecial compensalion or reimbursement or
representinp a not-(or-orofit basetl orpanizaGon for the ouroose of reQuestinq a qront without
soecial comoensation or reimbursement7
5) Pursuant to Ciry Cotle Section 2<91(1�, no campaign wnsultant shall lobby the Ciry Commission for a periotl o( 12 months
following the swearing in o(any elected official(s)for whom the campaign consultant provided campaign consWting services
within ihe past election cycle. See Section 2-091 tor more information.
Ves xNo: Have vou orovitled camoaion consullina services to an incumbent member o([he CiN Commission
within t�e past eleclion cvcle7lt ves,olease listthe incumbent memberlsl o(ihe CiN Commission:
Ves x No: If ves. has it been less lhan �2 months since the elecletl officiallsl whom vou orovitletl camoaian
consul[inq servites was sworn in7
6) Pursuant to Ciry Cotle Section 2d82(aq<)a., a lobbyist who has wilhin the past election cycle provitletl wmpaign consulting
services to an incumbent mem0er of ihe Gity Gommission (which lobbying activity is not otherv+ise pmhiDitetl by Cotle section
2-091) shall disclose such particular service on hislher lobbyist registration form antl shall orallv tlisclose such particular
service before lobbvino the QN Commission a�a oublic mee�ina.
� Yes X No: Have vou orovitletl campaiqn consultinq services to an incumbenl member of Ne City Commission
within the past election cvcle7 If ves,olease list[he incumbent membeAs)of the CiN Commission:
Ves x No: If ves, were vou oromised or ditl vou receive economic consitlero[ion in exchanqe (or camoaiqn
- consultina services?
TO BE GOMPlETEO BY QTY GLERK'S STAFF ONLY
e° �a �d a3 a �y
AnnualRegisVationhe: � ]Yes[ �No AmauntP`a�itlE�MCRt Oa[ePai
lobby at Reg s[ratio Form receivetl a tl e fietl by:1�
t v.. c ¢ >: � •.,,:..< .. .. .. ,., � �'��c.... ,.� �. :arz=c.rar 0.evised09/30/]O36
Page 3 of 5
�o .. ��. . >s. .,,� � .�,� aee��me oscraea �ee ����k��C'a������� �
� DacuSign EnvelopelD�F08DA339-AF5D-4136-AfiCF-B801B3564C3F
VI. SIGNATURES UNDER OATH:
ON FEBRUARV 28 OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNEO STATEMENT UNDER OATH. LISTING LOBBYING EXPENDITURES AS WELL AS GOMPENSATION
RECEIVED. FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WNICH THE
LOBBYIST HAS BEEN ENGAGED TO L08BY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENSATION DURING THE REPORTING PERIOD.'
Slgnalure of Lobbyist �� nw �, Da�e 3-11-2024
�Ecz.sc
I do solemnly swear or affrm that all of the foregoing facts, statements, and disclosures in this(orm are tme and correct,
and that I have read or am familiar with the pmvisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
the Miami Beach City Cod oan�al��,eporting requiremenls.
Signature of Lobbyist ��i�aw �AN4 Dale 3-1 b2024
sE cax���,��//////p���a�.: /J
Signature of PrincipaC ��"' �'�1 Dale 3'��-z�24
.�»oeen.on<so
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
srate of Florida State ot Florida
Counry oi: Miami-Dadc County oC Miami-Dade
Swom to (or aflirmed)and subscribed before me, Swom to(or affrmed)and subscribed before me,
by means of O physical presence by means of� physical presence
or� online notarization, or 0 online notarization,
this 1� day of nnarch . 20 24, by this 17 day of nnamh . 2024.by
William Lane Adam Borchers
NAME OF LOBBVIST NAME OF PRMCIPAL
_Produced ID _Pmduced ID
PoRM FORM OF IDENTIFICATION
z personally Known � � %Personally Known nI� �
��V1
:. SignaWre of Notary Pu c -���-- � Signature of Notary P :_--.--- ��--
Yeidy Montesino Perez Veidy Mantesino Perez
.., N e of N t v e , r'n e t ed Name of Nolary,Typed, Printed or Slamped
Yeitly Montesino Verez Yeitly Montesino Perez
Commission k HH 086f1� Commission#HH O8�]]3
Notary Public-S�a�e of Flontla
�My Commission Expires Jan 24 2025 Notary Public-Stale of Flonda
My Commission Expires Jan 24,2025
- 'T �. . .. ing persans:
N Expen wimesses who pmvitle only scientific,technical or olher specializetl Mtormation or lestimony in public meet
ings:any person who
anly appears as a represen[ative of a neighborhootl assacia�ion withoW compensa�ion or reimbursement for lhe appearance, whether
' tlirect, intlirect or contingent, to express suppoh of or opposition lo any item; antl any person who onty appears as a representative of
no4(or-proPo community basetl organiza�ion Por Ihe purpose of requesting a grant withoW special compensa�ion or reimbursemen� for
ihe appearance.
:. Page 4 of 5
� . . .u��.�+ ereu�m.oe vaaaaore aeEseeEaecaee ����h��k-'m?�����
� �ocu5gn Envelope ID�.FOBDA339-AFSD-4]36-AfiCFB001B3564C3F
Ciy of Miami Beaah, V00 Convemion Cemer Drive,Mlomi Beach, Florido 33139,www.mlamibeachfl.gov
Offlce of the Gry Clerk
Rafael E Granado, Ory Clerk CityClerk@miamibeachfl.gov
Tel'. 305.6737d1 I,Fox: 305.6737254
NAME OF LOBBYIST: William Lane
1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT
Pursuant to City Code Section 2-485(d), the City Clerk shall notiTy 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 fne of $50.00 a day shall be assessed for Statements filed after the
due date. The City Clerk shall no[ify the Miami-Dade County Commission on Ethics and
Public Trust of the failure of a lobbyist (or principal) to fle the Statement or pay the
assessed fines after notification.
Any lobbyist, who fails to file the required Statemeni by April 30'" of each year, shall be
automatically suspended from lobbying until all fnes 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 ihe 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.
- ��i(�io,+,e(Ain,t, s-ii-zoza
Signature o'�Lobbyisl Date
Feaea�5nuw=oaMsuoeevis*Foamsuoe�Ns�ReS�%��uon Form aen.we asl bso aEa.mc
.- Page 5 of 5
� o� o=easmfi seEeeeeaeeoee ,IIIhi�I�fiC''m.=1IIII }
..�..- . „-"c.a�e_neceg_<ceseee<F.�.r.
OocuSign EnvelopelD:F08�A339�AF5�-0136-A6CF-B801B3564C3F
Disclosure oflnterest
"Ike Smart City,LLC"
NAME AND ADDRE55 %OF OWNERSHIP
Peter D.ScanLantl 3228889%
Maltl�ew A.Scantland 17.42887% _
D.Alan Swntland 5-86206%
Peggy K.ScanllanE 5.08745X
250 NOM HaMord Avenue
CdumEus,Ohio d3222
No M�er persan or eniHy has more Man a 5%inlerest.
WA
I
� ° �� " "� ' ��°' " ' IIII�E�11111
Peqe6ol6 E6EetlBE0E0BE