Maefield Holdings
"
,.."
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the
passage, defeat or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision,
recommendation of the City Manager or any city board or committee; or any action, decision or recommendation of any
city personnel defined in any manner in this section, during the time period of the entire decision-making process on such
action, decision or recommendation that foreseeably will be heard or reviewed by the city commission, or a city board or
committee. The term speCifically includes the principal as well as any employee engaged in lobbying activities. The term
-Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST:
Karn
(Last)
Kobi
(First)
(M.I.) DATE QUALIFIED AS LOBBYIST
17100 Collins Avenue
BUSINESS ADDRESS: (Number and Street)
SUnny Isles Beach Florida
(City) (State)
33160
(Zip Code)
305-945-3636
TELEPHONE NUMBER:
305-945-3737
FAX NUMBER:
EMAIL:
I. LOBBYIST RETAINED BY:
Maefield Holdinas. LLC
NAME OF PRINCIPAUCLlENT:
1526 BlueiavWav
BUSINESS ADDRESS: (Number and Street)
Los Anaeles
(City)
Califomia
(State)
90069
(Zip Code)
310-360-7712
TELEPHONE NUMBER:
310-360-7711
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section If principal Is a Corporation, Partnership, or Trust [Section 2-482 (en
? NAME OF CHIEF OFFICER, PARTNER OF BENEFICIARY: Mark Siffin
? LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST
IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Gilbert Fein District
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of IndlvldualfTItle B) Relationship
Jome Gomez, Director None
Thomas Moonev None
William Carey None
. .'
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $150.00
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $150.00
Ii Yes~' A:;:;=:~:: ~o~c~~ ~r entity without soecial comoensation or
reimbursement. Pursuant to Ordinance No. 2004-3435.
1)
purs:::,nt to Ordinance No. 2003-3393 Amendinc Miami Beach Citv Code Chaoter 2. Article VII. Division 5
The f Entitled "Camoaicn Finance Reform" Via The Addition Of Code Section 2-4B8 Entitled "Prohibited
Camoaicn ContJibutions Bv Lobbvists On Procurement Issues":
i Yes ~~: :er:d~~~ ~::~~:ro:o~;:.'::~o~:~:~n~~~:;r aoods. eauioment or services. or on a oresent
rurs:nt to Ordinance No. 2003-3395 Amendinc Miami Beach atv Code Chaoter 2. Artide VII Division 5
her f Entitled "Camoaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaicn ContJibutions Bv Lobbvists On Real Estate Develooment Issues":
~'
ji1Yes ' : r 0 10 bin ndi a . tion r a D eon ar en h Ci
J :o~i~a~i~~ ~:r ~h~~:e :f :nln: ~::~:iana:on or :~~n~::O ~~ C:~ F~~:~ ~n~ U: :ao?
2)
V. SIGNATURE UNDER OATH:
I do solemnly swear that all of the for
am familiar with the provisions con
reporting requirements.
rect and that I have read or
Miami Beach City Code and all
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRIN
~duced ID k lJr L/. t. / 12
Form of Identification
SIGNATURE AND STAMP OF NOTARY:
CA ON:
~oduCed 10 ~I;/Jd (ft/- Llh..
Form of Identification ~'--'
.~~ i
o Personally known (Principal) "d! ." i
S:'WN
c'
!;S
i I j ~ ~~
J i III:
'111 ~I
Jill:
ignature of Public Notary - State of Florida ._........1
Notarization of Principal's signature
o Personally known (Lobbyist)
FOR CLERK'S USE ONLY
Annual Registra~~n fee: o Yes [~mount Paid I. MCR # ~/.. 'i'? rn Date Paid r // ..rjCJ</
LOboyisnregistration Form received and verified by:
Revised 02/10/04 F: CLER\A MARIA-M\LOBBYIS1\LOBBYIST FORM 04
1 First Revision - 05-17-02