2024 Lobbyist Registration Form - 6701 Collins Ave (David Martin) �
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?ECEIVED
� \' II/ \/ \� I `!F- �'`�I � p((iceo/theCityClerk 5tP 272024
1700 Convenlion Center Drive
Miami Beach, FL 33139 CIiY UF MiAMI 9EACH
305-8787411 OFRCE CFTHE CITY CLEFK
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employetl or retainetl, whelher paitl or not, by a pnncipal who seeks to enwurege the passage, Gefeat or
modifw�ion of any ortlinance, resoWYon. action or tlecision o!any rommissioner, any aclion, decisioq rewmmentlalion of Ihe City
Manager or any Ciry boartl or commillee',or any action,decision or recommentlation of eny Ciry personnel during ihe time period ot Ihe
entire tlecision-making process on such acGon, decision or recommendation that foreseeaEly will be �eaN or reviewetl by Ihe Ciry
wmmission. or a Cily board or commiflee. The term specifcaliy inclutles the principal as well as any employee engaged in lobbyin9
activities. The term'Labbyists"has specific exclusions. Please refar to City Cotle Chapter 2,Atlicle Vll, Division 3,enli�letl'Lobbyisls,'
foratlditionalinformation.
InatmcGane: Please comple�e all seclions of Ihis lorm and submil ihe campletad form,with Ihe applicable tee, to ihe O/fice of the City
Clerk. If you need more space m complete an answer, use a separata sheeqs) of papec If you hava nothing to report in a particular
section, you must wnte "none" or `nla' in ihat seclion. Any change lo any inbrma�ion ori9inally (led, ar any atltlilionai Cily
Commissioner or personnel who are also saughl to be lobbied shail require that the lobbyist file an amentlmenl b the regisVation form.
T�e lobbyist has a continuing tluty to supply in(ormation antl amand ihe brms filed thmughoul�he periotl Ihat Ihe lobbying occurs.
Separate registra�ion lorms shall be required�or each pnncipal re0�esentetl on each specifc issue.
I. LOBBYIST INFORMATION:
Dormnn Cory
NAME OF LOBBYIST (Lasp (Firsp (Mitltlle Neme)
Kimley-Horn 2 Alhambra Plaza, #5UU Cor�l Gables Florida 33734
LOBBYISTBOSWESSNMAEANOPODRE55 (NumberarM5Uee1) (CilyJ (Slate) (ZlpCotle)
305-673-2025 mry.dormanC�kimley-horn.cont
LOBBYISTBUSWESSTELEPHONENUM6ER CELW�AHTELEPHONENUMBEft EMAILADDRESS
II. PRINCIPAL INFORMATION:
Mzrtln Uavid
NAMEOFPRINCIPAL (Lasp (Flrsl) (MqeleName�
TMG 67 Coinmiuiifies LLC 3709 Crand Avcmre, #349 Coconut G�rove, Florida 33133
PRINCIPALBUSWESSNAMEANDAODRESS (NumberaMSVeep (City) (Siale) (ZipCotle)
305-416-4556 dmartin(�Jtcrragroup.com
PRMCIG0.LBlISINESSTELEPHONENUMBER CELWL4RTELEPHONENUMBER EMAILA��RESS
Pursuanl lo Glly Cotle Seclion 2-48Y���(1)(a)'. A pnnclpel ol eny mryoratlon. paMarship.or ot�er enlM�ap0eer5 as a lobbyist on pe�alf ol I�al
enuy,wilM1oul special compensalion or reim0ursemenl for Ibe appearance,xfietM1er tllrecl,inoirec6 or conbngenl.lo aKpress suppotl oi or opposllbn to
en Ilem s�ail register w�IM1 Ihe CIeM es reQuire�by I�Is subsec�len Lut sM1all nol�e requlree�o Day any reglsVa�lon(ees.
If the principal Is a Corporetion, Partnershlp or Trust, the following information MUST be provided
pursuant to Clty Cotle Section 2-482(c):
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,writa N/Aj: D. M�i'ti❑
. NAME OF ALl PERSONS HOLDING,�IRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION,PANTNERSHIP OR TRUST(if none,wri�e N/A�: 100% Devit�Mal'fin
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Oocusgn EnvelopelD:9E0B95C9�112F-058C-HCCGCF95225993A1
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.
Legislation and Development Approvals &PermiHing Issues, i�cluding but not limited to the HPB,
Design Review Board,Planning Board, Boazd of Adjustment,Land Use Development, City
Commission, and any City Workshops or Committees, if necessary, relating to the property located
at 6701 Collins Avenue 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 contrectual 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 generel nature of the subject contrectual relationship.
Full Name of Intlivitlual and Contractual Relationship(H yes,explain) vEs No
Title of Person [o be Lohbied '
Staff for the Planning & Building Department � None X
Public Works&Ci Administrallon,PB, HPB, BO None X
DRB, Citv Commission, and Mayor as necessary None X
Land Use&Sustainabili Comauttee None X
Pursuant to City Code Section 2-082(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
= a earance of im ro rie 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 Sea 2d85.3):
350
- $ .00 per hour
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The fallowing eix�6)questione MUST be anaweretl:
1) Pureuant ro City Catle Seclion 2-488,entilletl"Prohibiled Campaign Canlribulions By�obbyists On Pmcurement Issues".
_Yes xNo: Are 1 bb I t tli b'tl f tl i t e 1 t r
nentllnaawartltorpoods eauiomentorservlce?
2) Pursuanl ro City Code Seclion 2�490,entilled "Pmhibited Campai9n Contribulions By Lobbyisis On Real Eslate Oevelopmenl
Issues':
_YeazNo: Are I bb I p di II ti f D I tA 1 tlhih C'N f �I
foroh f d ' t' h t th CIN' F t L tl U M 7
3) Pursuanl to City Cotle Section 2482(h), airy person (except ihose exempt fmm Ihe tlefnition ol 'IobbyisC as set foM in
Seclion b481)who only appears as a represenlative o(a noFfor-pmftcorporation orentity withoutspecial wmpensalion or
reimbursement for Ihe appearence,whether tlirecl or indirecl to express support o�or opposition to any item,shall register with
�he ciry clerk as repuired by ihis section,but shall not be requireG lo pay any registralion lees.
_Vea zNo: Ara Y f 4f - flt tl Itl Nh t I I p 11
reiin4ureement7
4) Panuant �o Ciry Cotle Seclion P�481, Ihe Ierm "IobbyisC'speciGcally exclutles the bllowing persons: ExOeh wilnesses who
provitle only scientifc,technical or other spacializetl iniormation or testimony in public meetings', any person who onty appears
as a representa�ive of a neighCorhood associa�ion withoul wmpensalion or reimbursemenllor Ihe appearence,whether direct,
indirec�or wntingenl,lo express suppotl o!or opposi�ion to any item;antl any person who only appears as a rapresentalive ol
not-for-pmfi� communiry based organizalion !or Ihe purpose of requesling a granl wilhou( special compensa�ion or
reimbursemenl for ihe appearance.
_Ves %No: Are Idl I �Ifi � h 1 I lh ' II tl I I li u ¢ i
reoresentaUve of a nelahborhootl asaoclallon wllhout aoeciel eomoe�sallon or relmburaemenl or
rB C b! � ff b tl I tl � ih p S / tl q q t Ith t
SpBClal C0111PB088t1011 Of f2lRlbulsemenl�
5) PursuaM to Ciry Cotle Seclion 2�491(1), no campaign consultant shall labby the Ciry Cammission for a periatl of 12 months
following the swearing in of any elecletl oRicial(s) lor whom Ihe campaign consultant provitletl campaign consolting services
wilhin the past eleclion cycle.See Section 249� for mora iniormation.
Vee XNo: H Id d II' I � i b t b t�h CIN C I I
within iha oasl electlon cvcle7lf ves olease Ilslihe Incumbent membeAsl ol the CN Comm'ss'on�
_Yes x No: If es has It been I ee h n 12 m nlh In he elactatl ofticlel s wham au rovitletl ca
consullino aervices waa sworn in7
6) Pursuant to Ciry Cotle Section 2de2�a)(4)a., a lobbyist who has within Ihe pasl election cycle pwvitletl cem0egn consuiling
services to an inwmbent member ol ihe Cily Commission(which lobbying acliviry is not otherwise prohibitetl by Code seclion
2-E91) shall tlisclose such parlicular service on hisl�er lobbyist registralion form and shall arallv tlisclose such oarticular
semce before lobbvino the Gilv Comm'ss on a�a oubl c meelna.
Yes x No: Hava you provltled camoalan consultinq servicea ro an Incumbent member o(lhe C'iv Comm'ssion
wlthln lhe oast elecllon wcle7lf ves olease I'st the Incumbent member/a1 of the Citv Commisslon�
Ves x No: If e w r r i r ditl ou receive ecanomlc coneltleratlon In ezchan / r am al n
coneullina aervlces7
TO BE COMPLECTEO BV CITY CLERK'S STAFF ONLV � a
AnnualReglsValioniae. �Vas[ ]No AmomlPal/tl�i_�MCRN�� 7 OatrPe��
Lobbylel ReB�elration Fo�m recelveG antl ved0etl by: / � r
F:\CLFR\S/4{aFOPMS\L09BYISTFORMS\LObUyIi1P¢gi�mNeviseE09�30�i8AFG.tloc ReV15ltl09/]0/2018
Page 3 of 6 � �
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VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 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 S7ATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENSATION DURING THE REPORTING PERIOD.'
Signature of Lobbyist. Date
I do solemnly swear or affrm that all of the foregoing facts, statements, and disclosures in this form are true and correct,
and that I have read or am familiar with the provisions contained in Chapter 2, Ad. VII, �ivision 3, entitled "Lobbyists" of
the Miami Beach City Code and all reporting requirements.
Signature of LobbyisC ' Date ,,p
Signature of PrincipaC Date `�.� � �A� 1
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of Florida State of Florida
County of: Miami-Dade County of: Miami-Dade
Sworn to(or affirmed) and subscribed before me, Swom to(or a�ed) and subscribed before me,
by means of� physical presence by means of physical presence
or� online notarization, or O online notarization
this_day of 20_, by this�day of_�����2�;{by
Cory Dorman David Maxfln
NAME OF LOBBVIST NAME OF PRINCIPAL
Produced ID Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIRCATION
x Personally Known x Personally Known
Signature of Notary Public Signature of Notary Public
C.�V1,l,el � � ��,wl EfA
Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped
(NOTARY SEAL) (NOTARY SEAL �,— RLA�T�
5��� Sute of 485 da
�]� � � pHH6
�' f EPa
'+Q� ��rl 92M1 5
'The term"IobbyisP specifcally excludes the following persons: _�__ - _„ ,� .
Expert witnesses who provitle only scientifiq technical or other specialized information or leslimony in public meetings', any person who
onry appears as a representative of a neighborhood association without compensation or reimbursemen�for the appearence, whether
tlirect. indirecl or con�ingent ro express support of or opposition to any item; and any person who onry appears as a representative of
not-forprofit mmmuniry basetl organization for the purpose of requesting a granl without special compensation or reimbursement for
ihe appearance.
Page 4 of 5
Woisign Envelope ID�.9EOB95C9-]]2F-05BC-ACC0.CF95225993A]
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 COM !� (� DURING THE REPORTING PERIOD.'
SlgnaWraofLobbyisC �° '/���^' Date oe�2vzoza
I do solemnly swear or aHirm ihat all of Ihe foregoing facis, slatemenis, and discbsures in this form are tme and correct,
and ihat I have read or am familiar with ihe provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lo6byisls" of
the Miami Beach City C sall=Mporting requiremenls.
Signature oF LobbyisL e��'e���' Dale oenvzo2a
Signalure of Principal: Date
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
Sta�e of Florida State ot Florida
Counryot: Miami-Dade counryof, Miami-Dade
Swom to(or affirmed)and subscribed before me, Swom to (or aKrmed)and subscribed 6efore me,
by means of 0 physical presence by means of� physical presence
or Dlonline notarizalion, or 0 online notarization,
�his_day of oeizv2o2a 20_, by �his_day of 20_, by
Cory Dorrrtan David Martin
NAME OF LOBBYIST NAME OF PRINCIPAL
_Produced ID Produced ID
FORM OF IDENTIFlCATION FORM OF IDENTIFICATION
X Personally Kn (yp�—� x Persanally Known
. ,_.,.1,..,..... �
Signature of Natary Public SignaWre o(Nolary Public
- Diana Ramos
� Name of Nolary, TypeQ Prinled or Stamped Name oI Nolary, Typed, Prinletl or Stamped
_ oiana namoa (NOTARV SEAL)
Cammission%HH 38692]
No�ary Public�S�a�e oi FlonEa
= MyCammissionExpiresApri6,202]
_ ' ihe persons:
= Ezpert wi�nesses who proNtle onty scien�ific,�echnical or other specializetl infortna�ion or tes�imony in public meetings;any person who
only appears as a representa0ve of a neighborhood association without compensation or reimbursement for the appearance,whether
tlirec�, indired or con�ingent, �o express support of or opposi�ion�o any item; and any persan who only appears as a represeNative of
nohforproft communiy basetl organiza�ion for�he purpose of reques�ing a grant wi�hout special compensation or reimbursement for
[he appearance.
Page 4 of 5
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Wwsign Envelape IO'9EOB95C9-]]2FASBC�ACCGCF95225993A]
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Ciry of Miami!eo<h, V00 Convenno�Cemer Dd�e,Miom�Beach, Floddo 33139,www.miomibeachll.gov
OHice of ihe Ciry Clerk
Rafael E. Gronado, Ciry Clerk CiryClerk@mlomibeachN.gov
Tel: 305.673 747 1, Pox' 305.673 7254
NAME OF LOBBYIST: Cory Dorman
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 fle 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 30'" 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 regislered to lobby has concluded or I am no longer lobbying on
that issue, I shall immediately file a Notice of Withdrawal with the O�ce 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.
' �lA�st/bYwaU,
oe/212oz4
= Signature of Lobbyist Date
I �LI f InSPI IAa�ORMSLLOBBYI6I FORMSLLW�nsl Hegicnabn�mm RerixJ 0]V'e0 HF6 aoc
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