2024 Lobbyist Registration Form - MBVCA Annual Grant Application (Brittnie Bassant) Mf3vGd� - �n��o, l ���o,�.�
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RECENED
' ore�e orme ccy ae�k SEP 17 2024
1700 Conven[ion Center Drive
Miami eeach, F�33i39 Clll' OF MIAMI BEACH
305.673J411 OFFlCE Or-THE CITY CLERK
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retaineA,whether paid or not, by a principal who seeks ro enmurage the passage,defeat or
modification of any ordinance, resoWtion,action or decision af any mmmissioner, any action,decision,remmmendation of the City
Manager or any Ciry board or mmmittee;or any action,decision or rewmmenda[ion of any City personnel during the time period oft
entire decision-making process on such action, decision or remmmendation Ihat foreseeably will be heard or reviewed bythe Ciry
Commission, or a City board or committee.The term specifi�ally indudes the principal as well as any employee engaged in lobbying
ac[ivltles.The[erm"LobbylsP'hasspecifi�exdusions. Please refer[o Clry Code Chapfer2,Art7de Vll, Dlvision 3,en[IHed"Lobbyis¢;'
for additional information.
I ns[ru¢lons:Please mmple[e all se¢lons af[hls form and submlt[he mmple[ed form,wl[h the appllcable fee,ro Che Office of The City
❑erk. If you need more space to mmplete an answer, use a separate sheet(s)of paper. If you have nothing m report in a particular
�ectim,ryou mus[wri[e"none"or"n/a"In[hat sectlon.Any change ro any infarmatlon ongina Ily filed,or any additional Ciry
Commissioner or personnel who are also soughi m be lo6bied shall require[ha[[he lobbyist file an amendment m the regisnation fom
The lobbyist has a wntinuing dury ro supply information and amend the forms filed [hroughout[he period tha[the lobbying occurs
Separate registration forms shall be required for each principal represen[ed on each specific issue.
I.LOBBYIST INFORMATION:
NnmeoF�ooansT ��sq fF�rsc7 (Mr ieName)
TheFactorylnteractive 3250NE1stAveK305 Miaml F� 3313J
LOB8VI4BUSWESSNAMENNDAD�RE (Numberand5[reeq (Clty) (5[a[e) (ZlpCode)
305-JSb9400 J86�41L2832 jason@[hefamryicom
LOBBYISTBl151NES5TE LL - H EMAILADDRESS
II.PRINCIPALINFORMATION:
Bassant Bri¢nle
NAMEOFPRINCIPAL (La4J (First7 (MlddleName)
MIamlBeachChamberofCommerce 1920MeddlanAve Mlaml6each FL 33139
PRMCIPALBUSWESSNAMEANOADDRE55 (Numberantl5[ree[) (CiryJ �State) QlpCode)
305�fiJ4�1300 98b9A-0868 brittnle@mlamibeachchamber.com
PRMCIPALBUSWESSTELEPHONENUMBER CELWLARTELEPHONENUMBER EMAILADDRE55
Pursuant ro City Code Sec[ion b482�h)(1)(a�:A principal of any mrporation,parmership,or o[her en[ity who appearz az a lobbyist on behalf of[hat
entity,wl[hout speclal mmpensation or reimbursement for[M1e appearance,wM1etM1er tlirect,Indlrecp or mntlngenC m express support of or opposition t
an i[em shall regis[er wi[h[he Oerk az required by th'a subsection bu[shall not be requiretl to pay any regishation fees.
If the principal is a Corporation, Partnership or Trust, the following information MUST b�rovided
pursuant to City Code Section 2-482(c):
� NFMEOFCHIEFOFFICER,PARTNER,ORBENEFICIFRV(ifnone,writeN/F):_ _ _NA_ _ _ _ _ _ _ _ _ _ _ _
• NAMEOFALLPERSONSHOLDWG,DIRECTLVORINDIRECTLV,AS%ORMOREOWNERSHIPWTERESTINSUCH
CORPORAIION,PARTNERSHIPORTRUST(ifnone,w�iteN/N):_ _ NA_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _____
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i
III.ISSUE TO BE LOBBIED:
Describe with as much detail as is practical, incfuding but not limited to a specific description where
appficable of a pending request for proposal, invitation to bid, or public hearing number.
VGA Grant for the Miami Beach Visitors Center
IV.CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to Ciry 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 and Contractual Relatianship Qf yes,explain) �ES NO
7itle of Person to be Labbied
V6A Board Members for Tourism Grant None
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 rela[ionship giving rise to an appearance
of an impropriety, with any current CiTy Commissioner or City personnel who is sought to be 1o66ied as
identified on the lobbyist registration form filed.
List any Business, Financial, Familiat or Pmfessional Relatianship,or other relationship giving rise to an
a earance of impropriety(if none,write N/A):
I NA _ . . ... ..
._._.. ._. . ..... . .... .
V.DISCLOSE RATE AND AMOUNT OF L08BYIST COMPENSATION — Be Specific. Note that a
contingency fee is prohibited pursuant to City Code Sec. 2-485.3):
mn ---
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The toflowing siz(6)qucstlons MUST be answered:
1) Pursuantm Ciry Code Section 2-a88,cntiHed'Prohibi[ed Campaign Contributians By Lobbyists On Procurement Issues':
_ YBS X_N O Are you lobbying on a present or pending bid for goods equipment or services or on a present or
pentl mg award for goods,eqmpment or servme9
2) Pursuantm Ciry Code Section 2-49q eneHed'Prohiblted Campalgn Connibutions By Lobbylsa On Real Estate Develapment
Issucs":
YeSX NO'AreyoulobbvineonaoendineappliWtlonforaDeveloomentAereementwiththeClt4or
appGwtian torchan2eofzoninPmapdeslqnatlonorchanZetotheCitv'sFutureLandUseMao'+
3) pan�4trnQ6qc�ptleYfiers[i0a�rh4t�IGdm the definiCion of"IobbyisP'as set forch in
Section 2-481)who only appears as a representative af a not-for-profit wrporation or entirywithout special mmpensation or
reimbursement for the appearance,whether direct or indirect to express suppon of or opposition to any item, shall register witi
the ciry derk as required by this section, but shall not be required m pay any registtation fees.
�Y@S NO: Areyourepresentin�anot-lorprofltcorporaCionorantltVwiffioutspe[ialcompensation
orrelmbursement?
Pu�suant to City Code Sec[ion
4� ,Theterm "IobbylsC'speciflcalH,.4821udesthefollowingpersonrExpercwimesseswho
pravide only scientific, technical or other specialized information or res[imony in public meetings;any person who only appc
as a representative of a neighborhood asmciation wi[hout mmpensation or reimbursement for the appearance,whether di
indirect m mntingent,to express support of or appositian to any item; and any person who only appears as a representa[iv
no4Por-profit mmmuniry based organization for the purpose of requesting a grant without special mmpensa[ion or
reimbursement for the appearance.
_YBSX NO: AreyouprovltlingonWsclentific,technloalorotherspeciaGzedlnforma6on'appearinRas
ar�a re��sentafrveofanei hborhoodassociationwlthoutspecialwmpensafionorreimbursementorrepresenting
anot-�profrt as�¢ahon ort epurposeo req�estingagrantwit ovi�speaalwmpensationor
reim ursemen�7
Pursuant to City Code Section
5) , no campalgn consul[anc shaRi4�@�dhe CiryCommisslon for a period of 12 months
following the swearing in of any elecred official(s)for whom the campaigm m�sWtant provided campaigm m�sulting services
wiChin the past elec[ion ryde.See Section 2-491 for more information.
Y@SX NO: Haveyouprovidedcampaignconsultin�servicesmanincumbentmemberottheCity
CommissionwithinthepastelectioncY��e?Ifyes pleasefisttheincumbentmember(s)of[heCityCommission:
_ Y25 X_NOIt yes, has it been less than 12 months since the electetl official(s)whom you provided campaign
mnsultinR services was swom in?
6) petlahibyosbWh[q fiede�51@u6aK�¢93E�1@laion cycle pravided campaign wnsWting services to an incumbent member of
the City Commissian (which lobbying ac[iviry is not otherwise prohibited by Code section 2�491) shall disdose such
particular service on his/her lobbyist registra[ion form antl shall orally disdose su�h particular service before lobbying
the City Commission at a public meeting.
_ Y2S X_NOHave vou omvided camoai¢n wnsultin¢services to an'mcumbent memberof[he Citv Commission
withinthapas[elec[ionrycle71�yes pleasefistthaincumben[member(s)o(theCityGommission'
_ YBS X_N OIf ves,were you promisetl or tlid vou receive economic mnsideration in exchanZe for campaiQn
consultin¢services?
�moun TOBEACO�MPLpETE�BYCITYCL`ER'K'SSTAFFONLY
Annual Regisnation fee:[l Yes I No t Paid 8�Y�j_ _ _ MCR#/v� _ _ oate Paid��7��L�
__'- - - -
Lobbyist RegisVation Porm received and veri�ietl by:
r tl 03-11-3Q REG QQc. . . .. ..
t F n� � b ' ReviseA03/11/2020
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VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR. EACH LOBBV6T SHALL SUBMIT TO THE OFFICE OF THE CITV CLERK A SIGNED
STATEMENT UNDER OATH. LISTWG LOBBVING EXPENDITURES. AS WELL AS COMPENSATION RECEIVED FOR THE
PRECE�WG CALENDAR YEAR WITH REGAR� TO THE SPECIPIC ISSUE ON WHICH THE LOBBVIST HAS BEEN
ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO EXPENOITURE OR
COMPENSATION �URWG THE REPORTING PERIOD.1
Signature of Lobbyist Da[e���� � � y
i
I do solemnly swear or affirm that all of the foregoing facts, s[a[ements, and disdosures in this form are true and
mrrect, and that I have read or am familiar with the provisions mn[ained in Chap[er 2, ArL VII, Division 3, entitled
"Lobbyists"of the Miami eeach Ciry Code and all reporting requirements.
Signature of Lo6byist Date 09/0924
Signature of Principal: Date �/ • /.} • Y�
VII.NOTARV SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
5tare of Flofida State of �L
Counryof: Miami-Dade Counryof:� PaR�i — ��-
Swom to(or affirmed)and subscribed before me, Swom [o(or affirmed)and subscribed before me,
by means of o physical presence by means of o physical presence
or�online no[arization, or-�online notarization,
this 121h dayofSeptember 20?4, by [his�7dayof ��C'.�"``�+�' 7.�20?yby
Jasonlnasi � }�Cl }{'���/�o5S1./r}
NAME OF LOBBVIST NAME OF PR W OPAL
X Pradu[ed IDDL#1520-a36-73-102-0 Produced ID
��� FORM OFIOEMIFlCATION
_Personally Known �Permnally Known
.(O/Ld�L2� 9YG.1'YL!'IZBIZGY �
Signamre of No[ary Pu61ic 5 na[ure No[ary Public
Andrea Hammond � : p �..�d,�e 2
Name of Nocary,ryped, Princed or Stamped Name of Notary,Typed, Prin[ed or 5[amped
(NOTARVSEAL) � ��,,,�� (NOTARVSEAL) �,e^ P�IDM1�q�" w,
�..........HO ",n
��... _NO(ARYpG'GFj`<.
'Theterm^lobbyisP'specifcallyexdudesthefollowingpersons: ,-� MY� ��.�' s�_
� : EXpiR�'HMISSIpIy � '
Exper[wimesseswhoprovideontyscientific,cechnicalorotherspecializedinforma[ionortes[imonyi���{ me�t�A�3p eiso@who
���:
anly appears as a representative of a neighborhood asso<iation without compensation or reimburserg E the appearant2,v�hethei
direct, indirect or mntingent,ro express supparc of or opposition to any item; and any person who onfy;� apk}�A.sdl4re�tative of
noPforvprofit communiry based organization for the purpose af requesting a grant without special com" n bY.F�+i��eiement fi
the appea�anre. •,,..w,���...��.NN,o•eo.
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n��, � � nniRF,�CH
Ciy of Miami Beaah, V00 Convenrion Cenrer Dnve,Mlaml Bea<h,Flonda 33139,mvw.miamibeochFl.gov
OHice of rhe Ciry Clark
Rafael E. Granado, Cily Clerk CityClerk@miamibeachll.gov
Tel: 305-673 7411, Fox: 305.673 7254
NAME OF LOBBYIST: �ason Inasi
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 m file timely a Lobbyist Fee Expenditure and Compensation
Statement (Statement). In addition to any other penalties that may be imposed as
provided in Se�tion 2-485.1, a fine of 550.00 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 principap to file
the Statement or pay the assessed fines after notification. Any lobbyist, who fails to
file the required Starement 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 Ciry Clerk a signed Statement
under wth listing all lobbyist expenditures, as well as compensation received, for the
preceding calendar year with regard m the specific issue on which I have been
engaged to lobby.
2) LOBBYIST WITHDRAWAL
Once an issue I have registered to lobby has conduded or I am no longer lobbying
on that issue, I shall immediately file a Notice of Withdrawal with the Office of the
City Clerk.
ANNUALLOBBYISTREGISTRATION FEE
3� 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.
09/09/2024
Sigoature of Lobbyist Date
FpQER�SPLLVaPoPMSLOBBY Sf PoIMS1�bbyu:9eguuauon brm 0.evuetl 0]i I�ID P3C Joc
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