2024 Lobbyist Registration Form - Miami Vice 40th Anniversary (Derek Hedlund) M 'lal'�l + 1/ 1�
L� �� �D1hi ve,�Sc?�Cl�
/ " �
. RECEIVED
on�ce or me ary cie�k JUL 1 � 2024
, 1700 Convention Center Drive
Miami Beach, FL 33139
aos.s�a.�a�i CITYOFMIAMIBEACH
LOBBVIST REGISTRATION FORM �'RCE OF TNE CITY CIERK
Labbyist means all perwns employee or refained,whether paid or not, by a principal who seeks to encourage the pawage, deka[or
modificalion of any ordinance, resalulion, action or decisian of any commissioner, any action, decision, recommentlaoan af the Ciry
Manager or any City board or committee�, or any aclion,decision or recommentlation af any Ciry personnel during the Gma period of the
enYire dacisiommaking pmrass on such action, tledsion or recommentlation that foreseeabty will be heard or reviawed by the City
Commission, or a City board or mmmittee. The �erm specifically includes llie principal as well as any employee engagetl in lobbying
activities. The term "LobbyisP' has specific exclusions. Please refer to City Code Chapter 2, Arlicle VII, Division 3, enfitletl "Lobbyists,'
for additional inkrmation.
Instructlons: Please comple�all sections otthis firm and submit Me completed fortn,with ihe applicable fae, m Me Office otllie Ciry
Clerk. II you need more space ta complete an answer, use a separate sheet(s)of paper. If you have nothing N report in a paNwlar
sectioq you must write "none" or "n/a" in ihat sec9on. Any change to any inkrmation originally filed, or any additional City
Commissioner or personnel who are also sought to be lobbied shall require ihat the lobbyist tle an amendment to the registratlon krm.
The lobbyist has a mntinuing duty ro supply informaHon and amend lhe forms filed thraughout the period that the lobbying occurs.
Sepaate registrztion fortns shall be requiretl for each pnncipal represen�d an each speafic issue.
I. LOBBYIST INFORMATION:
Sharon Kersten Kersten Sharon
NAMEOFLOBBVIST (Last) (Firep (MiddleName)
Kersten Communications 2716 NE 32nd Street, Suite 4 Fort Lauderdale FL 33306
LOBBVI3TBUSWESSNAMEAN�ADORESS (NumberaMSiraet) (Clty) (Stete) (ZlpCotle)
305-458-3639 kerstenpr@att.net
LOBBVISTBUSWESSTELEPHONENUMBER CELLUTARTELEPHONENUMBER EMAILADDRESS
II. PRINCIPAL INFORMATION:
Derek Hedlund Hedlund Derek
NAME OF PRINqPFL (Lasi) (Firsi) IMltldle Name)
Taste the Race Events, Inc 20 Van Cortlandt Place Cortlandt Manor 10567-1540
PftWqPALBU91NES5NAMEAN�A�DRESS (NumberardSVeet) (CiryJ (State) 2�PCotle)
732-822-1975 � � Dmh262@gmail.com
PRINGPALBUSINESSTELEPHONENUMBER CELLUURTELEPHONENUMBER EMAILADDRESS
Pu(9uaM to Cly Gotle 6e[[lon 2-482(li)(1)(a): A prindpal o�arty colpo2tlon,petl(reisMp, Or Mher entity w�o appears an e lobby�st on behaR of�hat
entlty,wi�hou!special compeireatlOn or reimbursemeM br l�e appea�erce,whetM1er tlired,intli2d,or coMingen[,�o exprew support of o�oODosi�ion�o
an item sM1all regiater wtth the Cleh as requiretl�y[his subsectlon bN shall not be required to pay arry registation fees.
If the principal is a Corporation, Partnership or Trust, the following infortnation MUST be provitletl
pursuant to City Cotle Section 2-482(c�:
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARV Qf nane,Wri[e NlA�: �efek Hed���d
• NAME OF ALL PERSONS HOLDING, DIRECTLV OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SI1CH
CORPORATION, PARTNERSHIP OR TRUST(if none,wrlle N/A): MIChBBI N�0l8f12
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��
III. ISSUE TO BE LOBBIED:
Describe with as much detail as is practical, including but not limitetl to a specific description where
applicable of a pentling request for proposal, invitation to 6itl, or public hearing number.
Miami Vice 40th Anniversary Reunion Grant 24789 applied for
MBVCA Heanng on July 19, 2024 at 10:30AM
IV. CITY AGENCIESIINDIVIDUALS TO BE LOBBIED:
Pursuant to City CoAe Section 2-482(a��4�, list the City Commissioner or City personnel sought to be
lobbietl, and whether the lobbyist has entered into any contractual relationship (paitl or unpaitl) with
said City Commissioner or City personnel from 12 months precetling such commencement of service
with the City to the present tlate, stating the general nature of the subject contractual relationship.
Full Name ot Intlivitlual and Contractual Relationship(If yes,explain) VES No
Title of Person to be Lobbied
Miami Beach Visitor& Convention Authoriry X
Pursuant to City Code Section 2-482�g�, every ragistrant shall be requiretl to state the eatent 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 lobbietl as itlentified on the lobbyist registration form filed.
List any Business, Financial, Familial or Professional Relationship, or other relationship givin9 rise to an
a rance of im ro rie if none,write N/A :
N/A
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Soecific. (Note that a
contingency fee is prohibited pursuant to City Code Sec. 2-085.3�:
No compensation
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The follovring six(6)questlans MUST be answeretl:
� 1) Pursuantto City Code Section 2d88,entitled"Pmhibited Campaign Contributions By Lobbyists On Pmcurement lssues":
Ves xNo: Nre vou lobbvina on a oresent or centlina bitl for aooGs. eouioment or services. or on a oresent or
oentlina awartl tor aootls.euuioment or service?
2) Pursuan[to City Code Section 2d90. entitled 'Pmhibited Wmpaign Contnbutions By Lobbyis6 On Real Esbte Development
Issues".
_Ve52'jNo: Are ou lobb n on a ¢ntlin a Ilcatlon for a Oe ¢lo ment A reem¢nt wIM the Ci a�a Ilcadon
for chanae otzonina mao tlesianation or chanae to the CiN's FUNre Lantl Use Mao?
3) Pursuant to Ciy Code Section 2182(h), any person (except ihose exempt from ihe tlefnifion of"IobbyisC' as se[ foM in
Section 2-081)who only appears as a represenfative of a no4for-profit corpore6on or entity without speaal compensation or
reimburumant for tlie appearznce,whether direc[ar indirect fi express support of or opposition to any i�em,shall register willi
ihe city derk as required by ihis seclion,but shall not be required to pay any regisiration fees.
_Yes�No: Are vou reoresentina a nobfor-orofit corooration or entiN without sceclal comcensatlon or
reimbursement7
4) Pursuant m Ciry Cotle Section 3-087, the tenn "IobbyisY' specifwity excNGas the following persons' Expert witnesses who
provitle only scienfifc,technical or other specialized inkrmation or[estimony in public meefings:any person who only eppears
as a repreun4tive of a neighborhood associaGon withoutcompensation or reimbursement forthe appearance,wheMer direct
indirect or confingent,b express support ot or opposition to any item�.and any person who anly appears as a represenGtive of
noPior-proft wmmuniry based organizaeon for Me puryose of requeseng a grant wiMout special mmpensation or
reimbursementforthe appearznce.
VesXNo: Are vou orovidina onlv sefentlfic. technical or oMer soecializetl information: aocearina as a
reoresenbtive of a neiah�orhoo0 association without soechl wmoensation or relmburs¢ment or
reoresentina a noLforvoroRt basetl omaNzatlon for Me ouroose M reauestino a arant witliout
scetlal comoensaHon or r¢Imbursemenl?
5) Pursuant[o City Code Section 3d97(7), no campaign conwlhant shall lobby the City Commission for a periotl o712 momhs
following Me swearing in of any elected officia�(s)for whom the campaign consultant provitletl campaign ronwlting services
wifhin the pas[election cycle. See Section 2-091 kr more information.
Yes XNo: Have vou orovitletl camoaian consultlna services to an incumbent member of ihe CIN Commission
witl�ln the oast electlon cvele?If ves.olease Ils[the Ineumbent memberfsl of ihe CIN Commission:
V¢s No: It ves. has it been less Nan 72 monMs sinee the elec[etl oficlalfsl whom vou orovitleC camoalan
consultlna servlees was sworn In7
6) Pursuant m CiTy Cotle Section 1dffi(a��4�a., a lobbyis[who has within �he past election cyde provided pmpaign consulting
services to an incumbent member of the Clty Commission (which lobbying activity is no[othern�ise pmhibibtl by Cotle section
2-091) s�all disclose such partialar service on his/her labbyist regisNatlon form and shall o211v tlisclose such oarticular
service before lobbvino the CiN Commission at a oublic meetina.
VesXNo: Have vou orovitletl camoaian consultina services to an incumbent membe!of ihe CIN Commisslon
within the oast election cvcle4 IT ves.olease Ilst tlfe Incumbent memberfsl of the CiN Commission:
Ves No: If es re u ro isetl or d'd o reeel e ee nomic eons'tl roHon in achan e for cam af n
consultina services?
TO BE COMPLETED BY CITY CLERK'S STAFF ONLV
Annual Regisiralion fee: [ ]Yes[ ]No Amoun[Paitl S MCR N Date Paitl
Lobbyisl Regishation Fortn rxeiveE antl verifietl by:
IF ztif,a:uFlStlC8Yi4�MM5 >obM1yit;Re9i- nFuemfteuL+edUJ-ll�Y0R2<rAoc p¢YISE403�11�$020
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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 LOBBVING EXPENDITURES. AS WELL AS COMPENSATION
RECEIVED FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIS7 HAS BEEN ENGAGED TO LOBBY. A S7ATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
E%PENDITURE OR COMPENSATION OURING THE REPORTING PERIOD.'
Signature of Lo6byist: ,�i l i-�� ���- ���-� Date 7�( n-�vY
I do solemnly swear or affrm that all oF the foregoing facts, statements, and disclosures in this form are true and correcl,
and that I have read or am familiar with the provisions contained in Chap[er 2, AA. VII, Division 3, entitled "Lobbyists" of
the Miami Beach City Code and all reporting/re/quirements.
SignatureoFLobbyist: ti�'✓` v 'e'- �"—� Date 7�1- /�-`/
�"-/H/—Ti—/ ,
SignaWre of Principal�. \ /�./ f�NQ� Date 7`�q l2'��4'
u�.���
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL �
Stateof T�or,c��- SNateot IuuS -��c�S<-`�
Countyof: Pim�.,ar� Countyaf: Matn.�c�Hn
Swom to(or affijfnetl)antl subscribed betore me, Swom to(or a�rmed)and subscribed before me,
by means of��physical presence by means of L�physical presence
or�online notarization, or O online nofarization,
�his��day of Su1�_20�� 6y Nis iz day of 1.;�.�201-y, by
� �4�-wr� �,c� �S?�C r� De�re,FC q-Eed��v�c�
NAME OF LOBBYIST NAME OF PRINCIPAL
�ProducedlD�nr;d �,v�r L�u„se " ProducedlD /U5 �L--
FORM OF IDEMIFlCATI FORM OF IOENTIFICATION
Pe Ily n _�Perso�nally Known //
� / Gfi�� '���C,
' aWre of Notary Public S ure of Nolary Pu lic
t2�a�� n QA��1�e�. �. �� ,�.�+-a
Name of Notary,Ty d Name ot Notary,Typed, Printed or Stamped
'�� RICM,UDI.OAND4EIJR.
NOTARY SEAL Lp� �:': (NOTARY SEAL)
( � Notery Fublic�Stat¢of fbnE�
�� (ommRsionYHNu1�]E DFANJTARTA
���....,nn� MYC�m.Eipires�u 39.703)
9 Nutary Publlc,kate of New Jersey
'The term"labbyisf'specifcally excludes lhe fol owin9 persons: My[anmissian ExplresAug 1,2038
ExpeA wilnesxs wtro pmvide onty scientifc,�echnkal or other specialized infonnation or tastimony in public meetings;any person who
only appears as a representative of a neighborhootl association vnthout wmpensafion or reimbursement(or the appea2nce, whether
direc[, indirecl or contingenl, to ezpress support ot or opposition to any item; and any parson who onty appears as a representative of
no4forvproft community basetl organization for ihe purpose of requesting a grant without special compensation or reimbursement for
ihe appearence.
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i
Ciry d Miami Beach, 1700 Comenrian Cenrer Drive,Mlami Beoch, Florida 3313Q www.miamibeochFl.gov
Oflice of�he Ciy Clerk
Rafoel E_Granado, Cily Clerk Cih/Clerk@miamlbeachfl.gov
Tel'. 305 673741 7, Fox� 305.673 7254
NAME OF LOBBYIST: Sharon Kersten
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 tile 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 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
automaticaliy 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 lo lobby.
2� LOBBYIST WITHDRAWAL
Once an issue I have registered to lobby has conGuded or I am no longer lobbying on
that issue, I shall immediately file a Notice of Withdrawal with the Office of the Ciry 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.
� .. �_1'�- ��P� L V�" � � ��-��--
�Signature of Lobbyist Da
rw�eewu��rnrnsaoeariswRMsmmy.maeennaaoaro�aem:�e osn-me�m�
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