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2024 Lobbyist Registration Form - Information Technology Business Solutions (Tanya Donalty) „rrocrnotcon Tecl...ola�y L3� s;�ess Se1V4Sonf . .� �v�:�_; Iv11AMl �EACH OfficeoftheCityClerk 1 � !�24 1700 Comen[ion Center Drive Miami Beach, FL 33139 . 305.673.7411 LOBBYIST REGISTRA710N FORM Lobbyist means all persons employed or retained, whelher paid or not, by a pnncipal who seeks to encourage the passage, tletea[or modifcation o(any ordinance, resoWlion, action or decision oi any commissioner; any action, decision, recommendalion of the Ciry Manager or any City board or committee;or any action, tlecision or recommendation of any City personnel tluring the time period of the entire decision-making process on such action, tlecision or recommendation that foreseeably will be heaN or reviewetl by lhe Ciry Commission, or a Ciry board or committee. The term specificalty includes lhe pnncipal as well as any employee engaged in lobbying activities. The term "LobbyisP has specifc exclusions. Please refer lo City Cotle Chapter 2, Artide VII, �ivision 3, entitled "Lobbyisis,” for additional information. Instructions: Please complete all sedions of this form and submit lhe compleletl form,with the applicable fee,to the Office of the Ciry Clerk. I(you need more space lo complele an answer, use a sepa2te sheet(s)of papec If you have nothing ta report in a particular sec�ion, you musl wnte "none" or "n/a" in lhal section. Any change to any information onginally filed, or any adtlitional Ciry Commissioner or personnel who are also sougM to be lobbied shall require lhat the lobbyist file an amendment to lhe regis[ralion fortn. The lobbyist has a continuing dury �o supply informalion and amend the fortns fled throughoul the period ihat the lobbying occurs. Separate regisirdtion forms shall be required for each pnncipal represented on each specifc issue. I. LOBBYIST INFORMATION: Llorenle, Michael NAMEOFLOBBVIST (Lasl) (Firs�) (MidtlleName) LSN Partners 3800 NE 1st Ave, Suite 200, Miami, FL 33137 LOBBVISTBUSINESSNAMEANDA�DRESS (Numberantl5heet) (City) (Stale) (ZipCotle) 305-673-2585 michael.11orente@Isnpartners.com LOBBVIST BUSMESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Donalty, Tanya NAME OF PRINCIPAL (Lasl) (Firs�) (Mitltlla Name) Xerox Corporation - 1800 M Street, NW, North Tower, 5th Floor, Washington, DC 20036 PRINCIPALBUSMESSNAMEAN�ADDRESS (NumberantlStreeQ (Clty) (Slate) (ZipCotle) (703) 328-4994 (703) 328-4994 tanya@polcs.com PRINQPALBUSINESSTELEPHONENUMBER CELLUURTELEPHONENUMBER EMAILADDRE55 Pursuant to Ciry Catle Sec�ion 2d82(h)(1)(a): A pn^cipal of any corporation, patlnersM1lp, or other enidy who appears es a IOCbyin on behalf o(Mat entity,witM1OW special compensation or reimbursement tor Ne appearance,whe[her tlirec( intlired,or conGnBenl,to expren suOPOR of or opposi[ion to an item shall regisler wilh the Cletic as requireE by[his subsection but shall nol be requiretl to pay any registration tees. 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 BENEFICIARV(it none,write N/A): SteVell B8f1C�fOWCZBIC • NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,PARTNERSHIP OR TRUST(it none,wrile N/A�: �af4Vlf1 �@8SOf1 Page 1 of 5 � � III. ISSUE TO BE LOBBIED: Describe with as much detail as is prectical, including but not limited to a specific description where applicable of a pending request for proposal, invitation to bid, or public hearing number. 1V1tuWYA�1fM �-CG��V1Kl1.tt�S cn�Ul-�r S IV. CITY AGENCIESIINDIVIDUALS 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 ot Individual antl Contractual Relationship (If yes,explain) VES No 7itle of Person to be Lobbied Mayor&Staff N/A ✓ Commissioners & StaR N/A ✓ City Offcials & Staff N/A ✓ Pursuant to City Code Section 2-482(g), every registrant shall be required to state the e�Rent 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 lob6yist registration form filed. List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an a earance of im ro rie if none,write N/A : N/A V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note that a contingency fee is prohibited pursuant to City Code Sec. 2�85.3): NO (KlL�'F(Q�a� �0 Page 2 of 5 The following six(6)questions MUST be answered: 1) Pursuant to City Code Section 2d88,entitled"Prohibited Campaign ConUibulions By Lobbyists On Prowrement Issues": V¢s XNo: A I bb ' n o t d' b'tl i p tl t or services or on a t or pend'nqawartlforaoods eauiomen[orservice7 2) Pursuanl to Ciry Cotle Section 7-090,entitletl"Prohibi�ed Campaign Coninbutions By Labbyists On Real Es�ate Development Issues": Ves XNo: A I bb ' d' I' E f D I t Aq t 'th ih GN p I' f fo h u T d E h t th C'tY F t L d U M � 3) Pursuant to City Code Seclion 2-082(h�, any person (except ihose exempt from lhe defnition of "IobbyiSC as set forth in Section 2-481)who onty appears as a representative of a noFfor-proft corporation or enlity withou� special compensation or reimbursemenl for the appearance,whether direct or indirect to express support of or opposition to any item,shall register wi[h lhe city clerk as required by Nis section, 6ut shall not be required�o pay any registrelion fees. V¢s XNo: A o f bf - ft f CN �th t ' I D f reimbursement7 4) Pursuant to City Cotle Sectian 2d87, the tertn "IobbyisC specifcalty exclutles the following persons: 6cpert witnesses who provide only scientifq technical or other specialized information or testimony in public meetin9s;any person who only appears as a represenfalive of a neighborhood association without wmpensalion or reimbursemen�for the appearance,whe�her direc[, intlirec�or wntingent,lo express supporl of or opposition to any i�em;and any perwn who only appears as a representative of noFfor-proft communiry based organizalion for lhe purpose of requesling a grant without special compensation or reimbursemenl for the appearance. Yes XNo: A o �d I se¢ntfc lechn'cal or oth¢r soecal'zed 'niorma[lon� aooearina as a p t C f 'ahb rh d assoc'afan w'thout soei al compensalion or reimbursement or p Y a tf p fit b d q ' t' f th D o � sC�a a t �th t soecial comoensation or reimbureement9 5) Pursuanl to City Code Section 2-097(1�, no campaign consultant shall lobby the City Gommission for a period of 12 months following the swearing in ot any elected offcial(s) kr whom the campaign wnsultant provided campaign consulting services within the past election cycle.See Section 2-09t Por more information. Ves XNo: H 'd tl o � Iti o t n 'n umben[member ot ihe C'N Comm'ss'on 'th' th o t I t' I T IT ol I' t ih 'ncumbent memberlsl o!the C'N Comm'ss'on: Ves X No: ��o= has It b I th 12 months s'nca the elected a(flc'al(s) whom vou orovided camoaian eonsulCna servlees was swom inT 6) Pursuant to City Code Seclion 2A82(a�@)a., a lobbyist who has within the pasl elec�ion cycle pmvitletl campaign consulting services to an incumbent member of�he Ciry Commission (which labbying activity is wt otherviise pmhibiletl by Code section 2-091) shall disclose such particular service on his/her lobbyist registration form anC shall orallv d'sclose such oarticular servi ce before lobbv no the CN Comm'ss on at a oublic meetina. Ves XNo: H 'd d It' t n 'ncumbenl member of Ihe C'N Comm'ssion 'th' th o t I E I �If ol f t lh ' cumbent member(sl o([he C'N Comm'ss'on' Yas XNo: If tl d'd e've econom'c cons'derot'on 'n exchanae for eamoaian eonsultina services7 rfcV�aV3, :�¢(Z TOBECOMPLETEDBVCRYCLERK'SSTAFFONLV �' �/'� ^ L/ AnnualRagla[a[lontee: [ ]Ves No AmountPeid��• MCR�—/J��C3 OataPal � � Lobbylat ReB�stration Fa�m�anlveE antl verifled by: F:\LLER\SALL\aFORMS�LOBeYI5TFO0.M5\Lohbyis[Rgis4a(ionPo�mRevis¢tl 03-11400.EG.Eo[ RCV19GA03/SS/�1020 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 TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO EXPENDITURE OR COMPENSATION DURING THE REPORTING PERIOD.' Signature of Lobbyist�. Date I tlo solemnly swear or affrm that all of the foregoing facts, statements, and disdosures in this form are tme and correct, and that I have read or am familiar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Date Signature of Principal: Date 4�4�z�Z4 VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of State of Virginia County of: County of: Prince Wlliam Swom ro (or affrmetl) and subscribed before me, Swom to(or affrmed)and subscribed before me, by means of O physical presence by means of� physical presence or O online notarization, or 0 online notarization, this day of , 20_, by this 4th day of Aoril . 2024, by Xerox Corporation NNME OF LOBBVIST NAME OF PRINCIPAL Produced ID Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION _Personally Known X Personall <nown _ L Signature of Notary Public i� ture of Notary Public John F. Bedenbaugh Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stampetl (NOTARY SEAL) (NO - � ��ohn Framz BedenOavgn Commonwealih o�V�rqima � Notary Public � Coinmission No.1�19]3E �,`y��y�, MyCommissionEapres9fJ�^2016 ' The term"lobbyisf' specifcally ezcludes the following persons: Expert witnesses who provide only scientifq technical or other specialized information or testimony in public meetings',any person who only appears as a representative of a neighhorhood association without compensation or reimbursement for ihe appearance, whether direct, indirecl or contingent, m express support of or opposi�ion to any item; antl any person who only appears as a representative of not-for-proft communily based organization for the purpose of requesting a grant without special compensation or reimbursemen� for the appearance. Page 4 of 5 VI. SIGNATURES UNDER OATH: ON FEBRUARV TB OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE OFFICE_OF THE CITV 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 TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO EXPENDITURE OR COMPENSATIO DURING T E REP RTING PERIOD.' Signature of Lobbyis[ {�� i � �^� Date y� C�1 �� —T� � i (� I do solemnty swear or affirm that all of he foregoing facts, statements, antl disclosures in this form are true antl correct, and that I have read or am familiar with the provisions contained in Chapter 2. Art. VII, Division 3, entitled "Lobbyisls" of the Miami 8each City Code and all re ortin req -re ents. SignaWre of LobbyisC Dale � ��1� � SignatureofPrincipaP. � Date VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of Pl0Y1l�U State of County of�. N�Inw.1 —�[� County of�. Swom to (or affir�''ed) and subscribed before me, Swom to (or affirtned) and subscribetl before me, by means of GYphysical presence by means of O physical presence or 0 0qline notarization, or O online notarization, this 'l day of�A,n..� . 2�, by this_day of 20_, by rn�cxvac� ucuM+c NAME OF LOBHVIST NAME OF PRINCIPAL Produced ID Produced ID � FORM OF IDENTIFlCATION FORM OF IDENTIFlCATION �Personally Known Personally Known �� SignaWre of��ublic SignaWre of Notary Public �1vlCYV� �-�v (i✓D Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped (NOTARY SEAL) ��'°� vlvi¢,yRrv¢Fo NOTARY SEAL) �-- notnryp DGc-Stxteo/Flonea ��F�� Canm�ssa Y�IHIJO�S� MYCwnm.Eiplrei°^C O.EJ26 ..�BonEeE r h Nallona�n l3ryasln. ' The term"IobbyisC specifically e Expert witnesses who provide onty scientifq technical or other specializetl information or testimony in pu�lic mee�ings, any person who onty appears as a representative ofa neighborhood association wrthout mmpensation orreimbursementforthe appearance, whether tlirecl, mdirect or contingenl, to express support of or opposilion to any item�, antl any person who onty appears as a representative of not-forvpro�it communiTy based organlzation for the purpose ot requesting a gran�without special compensa[ion or reim0ursement for Ihe appearance. Page 4 of 5 MIAMIBEACH Ciy of Miami Beach, 1700 Comamion Canrer Dme,Miaml Beach, Flonda 33139,www_mromibeochlLqo. Of6ce of the Ciy Clerk Rafael E Gmnado, Cify Clerk Cih�ClerkC�miomibeachfl.gov TeP. 305b737411, Fax�. 305.673J254 NAME OF LOBBYIST: �(�q�kCl LllMN1'G 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 fle the Stalement or pay the assessed fines after nolification. Any lobbyist, who fails to fle the required Statement by April 30'" of each year, shall be automatically suspended from lobbying until ail 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 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 ihat 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. /� �l[Oa I 2�1 Signahy e gf Lo st Date �/ F�!CLER\$PLL�a�ORM91LO0BVi5i FoRMSLo�Dynl ReB�SYalion Form RenseO 69 1 bR0 REG dw Page 5 of 5 CriY ol N¢unl UU�cM1 I:i�Y Ilal l .,-� C1 voo u�uvuilfnn f,enler �r. v D =i" n � - o a � � n 3 Hiami Hear.h , fl 33139 m n = � 'o' � _ - o- � d � � 305-6/3-i4'LO u °c G � � - N c' � p m Welcooie m °. � a � � _ = t0 — o .n � o � =� � � � ° 3 � � � � °` `� 'w a � � 04/12/2024 10:56AM Moises C. 3 � OOfi901-0006 A � o �� ; � a �o ft m MISCELLANEOl1S . z �- ' a n � Referanca 1: MCR433239 c c _ ❑ � MCR OPEN (MCR) 2024 Item; MC� � c � � » 1 � �'350.0000 m o `° � n 14CR OPEN (MCR) $350,00 n� '_ � u 3 ---- -__.._.__ o 5350.U0 � m Subtotal 5350.00 � IDtal 5350.00 CHECK �350,OU � m Check Nwnber00121! � _. .. _ ....___.. . y Chanpe due �0.00 � ` Paid 6y: LSN PARTNER6, LLC . � � z i o 0 I�NI�I��I��I��I�I��H��'�,��I��'I��q��1 I T w w � N N W „__ __... ._.. ��p 3 N fO L�6�1� "'J.�i..� m . n p m�in y O I .. W'ZLry6• ��bv.. ._. _ _.______ . twm � bWVWi1.r1.11y.1Y+.�-- --.-y-..,�.. A n '"'.�.�.".."'.. �"�ii _�l<-�-fXt�__� o Thank you far yo�ir payment Ct1SI�MEP. COPY � � � - �