2024 Lobbyist Registration Form - Transfer of CUP (Dhanushan Gunasekaram) -r�a�� oz �u p
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1700 Convention Center Drive
Miami eeach, FL33139 . � . p.'�.1�;:.��,I rt�.-���'l i
305.673.7411 . n . . , , . . .
L09BYIST REGISTRATION FORM
Lobbyist means all persons employetl or retained, whether paid or not, by a principal who seeks to encourepe t�e passage, tlefeat or
modifcation of any ordinance, resolution, action or decision of any wmmissioner, any action, decision, recommentlation of the Ciry
Maneger or any Ciry�aard or committee�,or any aciion,tlecision or recommentlation of any City personnel tluring ihe time periotl of the
entire tlecisionmaking process on such actian, tlecision o� recommantlation tha� foresaeably will be hea�tl or reviewetl by the City
Cammission, or a Ciry boer0 or committre. The tertn specifcally inclutles the pnncipal as well as any employee engageG in lobbying
activities. The term "Lobbyist"has specific exclusions. Please refer to Ciry CoGe Chapler 2, ARicle VII, Oivision 3,entitleC 'Lobbyists,'
hr atltlitional infortnatian.
Inatructlona: Please complete all sections of lhis fortn anG submit Ihe completed fortn,with ihe applicable fee,to the Office of ihe Ciry
Clerk. If you need more space ro complete an answer. use a separata sheet(s) of papar. If you hava nothing to report in a particular
section, you must write "none" or "n!s' in that seMion. Any change to any inPormation originally fileq or any adtlitional City
Commissionar or personnel who are also sought to be lobbied shall require ihat ihe lobbyist file an amenEment ro tha registretion fortn.
The lobbyist has a continuing tluty to suppty inFormation antl amentl the tortns Flletl ihroughout ihe period that the lobbying occros.
Sepereta registretion forms shall be requiretl for each prinapal represantetl on eac�specific issue.
I. LOBBYIST INFORMATION:
de la Fuente Domingo ("Bob") de la Fuente
NAMEOFLOBBVI9T (Last) (Fl�sl) (MiGtllaName)
Lehtinen Schultz PLLC, 1200 Brickell Avenue, Suite 507 Miami FL 33131
LOBBVISTBUSINESSNAMEHNDHD�RESS (NumbereMSireep (Clly) (S�ale) (ZipCOJe)
305-760-8540 BdelaFuente@Lehtinen-Schultz.com
LOBBYISTBl15MES5TELEPHONENUMBER CELWLARTELEPHONENUMBER EMAILADDRESS
II. PRINCIPAL INFORMATION:
Gunasekaram Dhanushan
NAME OF PRINCIPPL (Las�) (Flrsl) (Mitltlle Name)
Mynt Soluna LLC 1700 Meridian Ave., Apt. 312 Miami Beach FL 33139
PRINCIPALBl1SME55NAMEANDADDRE55 �NumLerenGSVeeI) (Qly) (State) (ZiDCotle)
305-760-8515 hello@dangunam.com
PFINCIPALBUSMESSTELEPHONENUMBER CELWLHRTELEPHONENUMBER EMAILA�oRESS
PURuant�o Ciry Cotle Seqion 2-a82(h)(i)(a7: A pnn<ipal of any corporallon, patlnersNp, or M�er entlry wl�o appears as a b00yis�on behalf of Ilul
entiry,without special compensation or reimbunemenl for Pe apPearance,whether tlirect IMirec[or coMingeM,to express supPotl of ar opposllion to
an ilem sha0 register wi1F IM1e Qerk as requitetl by IM1is suDsec�ion Oul sM1all no�be reQuiretl lo pay any regisVa�ion fees.
I( the principal is a Corporation, Partnership or Trust, the following information MUST be provided
pursuant ro City Cotle Sectlon 2-082�q:
• NAME OF CHIEF OFFICER,PARTNER,OR BENEPICIARV(If none,wri[e N/A�: DhanUsh3f1 GUn2Sekalam
. NAME OF ALL PERSONS HOLDING,DIRECTLV OR INOIRECTLV,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION,PARTNERSHIP OR TRUST(if none,wnte N/A�:
Dhanushan Gunasekaram� Simrit Khanqura
Page 1 of 5
�/�.I
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� III. ISSUE TO BE LOBBIED:
Descri6e 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.
Transfer of CUP.
IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-082�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 general nature of the subject contractual relationship.
Full Name of Individual and Contrac[ual Relationship (If yes, explain) �ES NO
Ti[le of Person [o be Lobbied
Planning Department x
Planning Board X
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 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 Sec. 2-485.3):
$550/hour
Page 2 of 5
- The following six(6)questions MUST be answeretl:
1) Pursuant to City Code Section 2-068, entitled"Pmhibitetl Campaign Conlributions By Lobbyisis On Prowrement Issues"�.
_Ves yNo: A v I bb ' a t o d' b'd t q tl 'o t rv'ces or on a oresent or
p d" q tl f ds eo ' t or service�
2) Pursuant to City Cotle Section 2-090, entitletl'Prohibitetl Campaign Conlribu[ions By Lobbyists On Real Estale Development
Issues"'.
_Yes�No: A I bb ' o tl' I' at f D I o tA men[w'ththeC'Noraoolicalion
t h q f ' 4 o tl 'a £o h q t th C'N' F t re Lantl Use Mao7
3) Pursuant to CiTy Cotle Section 2-082�h), any person (except those exempt fmm lhe defnition of "IobbyisP' as set forth in
Section 2-481)who only appears as a representative of a no4forvpmfit coryoration or entity without special compensation or
reimbursement for ihe appearance,whether direct or indired to express support of or opposition to any item,shall register wilh
the ciry clerk as requiretl by this section, but shall not be required lo pay any regis�retion fees.
_VesxNo: A v e t q tfo o f[ Y ft '[h t ' I com Con or
reimbursement7
4) Pursuant b Ciry Code Section 2387, the term "lobbyisC' specifically exdutles Ihe following persons Expert witnesses who
provide only scienlifiq technical or olher specializetl information or testimony in public meetings�, any person who only appears
as a represenlative of a neighborhootl association without wmpensation or reimbursement for the appearence,whether direct.
intlirect or contingent, ro express support of or opposition lo any item'. antl any person who onry appears as a representative of
nobforprofl community based organization for the purpose of requesling a grant without special compensation or
reimbursement for the appearance.
_Yes�No: A v o �d� a I 'e Yf' t h ' al o th c'al'zetl 'nformaton� aooearina as a
p Wf f ' hb a d ' Co th t 'al com fon or reimbursement or
p C q t f D ft b d a ' f f [h o D f n f a a t 'lh t
sDec'al comoensation or reimburs¢ment9
5) Pursuant to City Code Section 2-491�1�, no campaign consultant shall lobby the Ciry Commission for a period of 12 monihs
following Ihe swearing in of any elected official(s) for whom the campaign consulcan� provitletl wmpaign consulting services
within the past elec�ion cycle. See Section 2-491 for more information.
Ve3( No: H o 'tl tl a'a It' s t 'ncumbent member o(the C'N Commission
'th' th p t I f v I 9 I( ol I' t th 'ncumbent memberlsl of the Ciri Commission:
Ves No: � �� h 't b I th 12 o th lhe electetl oRc'al(sl whom vou orovidetl camoaiqn
consultinn services was sworn in?
6) Pursuant lo Ciry Cotle Section 2382(a�(4�a., a lobbyist who has within the pas� election cycle pmvided campaign consulting
services ro an incumbent member of the CiTy Commission (which lobbying activity is not otherwise prohibitetl by Code section
2-491) shall tlisdose such particular service on hislher lobbyist registretion form nd shall oralN d'sclose such oarticular
b f I bb - Ih Ct C af o bl fno.
_Yes�No: H v p o �detl u � co It q 'ces to an 'ncumbent member of the Ciri Commission
'Ih' th t I C I ?If I f t lh ' b n[member(sl of th¢C'tv Commission:
Ves No: If v a d o dtl vi ce've econom'c cons'tlerat'on 'n exchanue for camoaiqn
consultina services?
TO BE COMPLETED BV CITY CLERK'S STAFF ONLY
Annual Registra[ion fee: � ]Vas[ ]No Amount Paid 5 MCR# �ate Paitl
Lobbyis[Registra[ion Fortn receivetl antl verifietl by:
F:\CLER\$ALL\aFO0.M5\L09BYISTfORMS\Lobbyl4RdJIR�a[ionFormRGVI5etl03-1140REGA0[ RlVISl4�1/11/3020
Page 3 of 5
VI. SIGNATURES UNDER OATH:
ON FEBRUARV 26 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 7HE 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 COMPENSA�1 N DURING THE REPORTING PERIOD.'
Signature of Lobbyist -�� �� � ��` Date S�/n'/ =� �'�
I do solemnly swear or affirm ihat all of the foregoing facis, stalements, and disclosures in this form are true and correct,
and that I have read or am familiar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
Ihe Miami Beach City Code and re o in re .yire enis.
SignatureofLob6yist `� Date s���� ���
Slgnatura of Principal: _ / Date �1��� � 7 �� �f �
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
�Gov�a�cz �
State of i'� �Y I� �tete of �7;��F� �u
County of: 1�1�Q,V1'1 I �-�C�..�- Counry oE �- �''^'A 7�
Swom to(or aHirmed) and subscribed before me, Sworn to(or affirmed) and subscribed before me,
by means of;�.physical presence by means of 0 physical presence
or 0 online notarizat o, , or O online notarization,
this 1(Z day of 4 20�y this_day of 20_, by
- � Dhanushan Gunasekaram
NAMEOF BB T NAM FPRINCIPAL
Produced ID Prod ced ID 1�-���5 uC
F M � I�ENTIFICATION FORM OF IOFNTIRCATION
�Personal � f/Srio Person \ n n �
I
Signature of ('[,ary u lic Signat re of otary IPub i
1 XL` �1 �4 I��/�L` -ii�f� Vr��
Name of N tary,Typed, Pciq S am ed Name o Notary, Typed, Printed or Stamped
(NOTARY SEAL 3P`��Uk%SNota�pvbilcM. CAMPO TARV SEAL)
) _ _ �Y Stete of Florl a
_:��e Commieaion 1 HH ]912J<
�„iq�� MyCommineionExpirea
SeD[ember f 0, 2018
� The term"IobbyisP'specifcally excludes t e o owin .
Expert witnesses wM10 provitle only scientific,technical or ather specialized information or�estimony in public meelings; any person who
only appears as a represenlative of a neighborhootl association without compensation or reimbursement for�he appearance, whether
direc[, indirect or wntingen( to express suppoh of or opposition to any item�, antl any person who only appears as a representa[ive of
nob(or-profit communiry basetl organiza�ion for the purpose of requesting a grent without special mmpensation or reimbursemenl for
Ihe appearance.
Page 4 of 5
' . . . . � �"! ,� A, ;� �--�
Cily oi Miami Beach, V00 Convention Cenrer Drive,Mlaml Beoch,Florida 33799,vm^w.mlomibeachfl.gov
Office of Ihe Cly Clerk
Rafoel E. Granado,City Clerk CityClerk@miamibeachfl.gov
Tel�. 305.673 7411, Fax: 305.6737254
NAME OF LOBBYIST: Domingo ("Bob") de la Fuente
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 aker 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 Statement or pay the
assessed fines after nolification.
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 fne 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 lhe 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.
����2�C�'� �� S �/0� ��-,
Signature of Lobbyist Date
FVLLFA4NLL1aPoflMS�OB9YlY FORMS�Lo��yiA Regl¢I211on FD�m Revise] P9-01-3G REG tloc
Page 5 of 5
ciry o� Nlami tleach
City Hdll
170U Conveutiwi Center �r.
Miami 8each , FL 33139
305-fi73-7420 3 � � � � o a � ❑ ^ 3
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MISCELLANEOUS � - n m °J
Reference 1: MCR4334U8
MCR OPEN (MCR1 , c i �
2024 Item: MCR � �
1 C� $1,200.0000 0
MCR OPEN (MCR) $L20G.00 � �
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Subtntal 51,200.OU
Total 51,200.00
CNECk $35U�00
Check Num�er003397
CHECN E35G.00
Check Number003398
CHECN 5500.OU
Check Num6er003399
Chanee due i�.00 � ,,, Z
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Paid 6y: LEHTINEN SCHULTZ PLLC �'
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