Juan Fernandez-Barquin/Rita & Steven StarrMIAMIBEACH
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 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 Ordnance 2004-3435.
Fernandez-Barquin Juan ~ ,
NAME OF LOBBYIST: (Last) First) (M.I)
~~'~'~ ~ERb.t ~ ~ ~- ~~ N ~ Miami, Florida 3 3) '~ L
BUSINESS NAME AND ADDRESS Nurf~ber and Street
( ) (City) (State) (Zip Code)
~1~~-33k6-DP381 `?~G-3~6.-(>~~'~ ;~ ~ eng~fo~~(5o~.~-I-~-- nE
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Rita and Steven Starr & Kelapa Investments, Inc. (Rita Starr, President)
NAME OF PRINCIPAL/CLIENT:
1810 Michioan Avenue Miami Beach FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)525-5535
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Rita Starr
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE: ~'
` Redevelopment of 604-08 Collins Avenue and 215 6 Street
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title I B) Any Financial, Familial or Professional Relationship
Planning Dept., HPB, BOA, Planning Board, City Commission None
x~'?~1~ ~11~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
'" ' ,,, FLATRATEOROTHERf
A) LOBBYIST DISCLOSURE: (Required) $ ~ "- >i~r 2~ y ~
+ B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ ~'~ ~ ~ ~l Z S~ .or
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^ Yes X No: Are you lobbvin4 on a present or vendin4 bid for goods, equipment or services, or on a
present or vending award for goods, equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled'~Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes X No: Are you lobbying on a vending application for a Develovment Agreement with the Citv or
aipplication for chance of zoning map designation or chance to the City's Future Land Use
Ma°?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of a not for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees_
^ Yes X No• Are you revresenting anot-for-profit corooration or entity without svecial compensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT T THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, S WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECED AR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPE RES CO ENSATION DURING THE
REPORTING PERIOD.
I do solemnly swear that all of
familiar with the provisioq~
requirements. ((
Signature of Lobbyist:
facts are tr'Ge and correct and that I have read or am
~ 2-482 of the Miami Beach City Code and all reporting
PRINCIPAL IDENTIFICATION:
^ Produced ID
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn toad bscribe b fore me
This r~ d Y of 200$
t~ublic Notary -State of Florida
~n of lobbyist's signature
iCGi K~t~S
Annual Registration fee: [ ]Yes [ ] No
Form of Identification
ersonally known ( ' ••~"' LAYNEHARRIS
.,,: .~ MY COMMISSION # DD 534759
A ~ EXPIRES: March 30, 2010
•1~Pf ~~. Baeled Thiu ~ry PubAc Undenvrflers
State of Florida, County of Miami-Dade
Sworn and subscribed before me
Thi day of 20~~
_.-
ignatu of Public Notary -State of Florida
Notarization of Principal's signature
FOR CLERK'S USE ONLY
Amount Paid MCR # Date Paid ~ ~ fl
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc
Entered By:
Revised 12J08/04
G~w+~
City of Miar»i Beach, 1744 Convention Center Drive, Miami Beoch, floric~o 33139, www.momibea~hfl.gov
CITY CLERK Q?flce C:lyC(erk~miamiberschfl.gav
Tel: 345.573.741 1 ,fox: 345.b73.7254
LOSBYIS? NAME:
I understand that na later than Ccbber i st of each year, I must file the following
forms, pursuant to Section 2 483 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
i } Lobbyist Expenditure Form
2j Disclosure Form
Failure to file these forms an a timely basis will result in my name being transmitted to the
Miami-Dade County Commission on Ethics and for code violation evaluation.
In addition, ante an iss~e 1 have registered to lobby on has been resolved, t am required
to immediately notify #h City Clerk's Office of lobbyist withdrawal in writing.
_~_ ~ l Q ~
Signatur : Date: