Neisen O. Kasdin/Akerman SenterfittM n-,•, Fc.~.~,
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City of Miami Beach Office of tl~e City Clerk.
170Q Convention Center Drive, Miami Beach, FL 33I3~}
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 Ordinance 2004-3435.
Kasdin Neisen O.
NAME OF LOBBYIST: (Last) (First) (M.I)
Akerman Senterfitt One SE Third Avenue, Ste. 2500 Miami FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 374-5600 (305) 375-5095 neisen.kasdin@akerman.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Publix Supermarkets, Inc.
NAME OF PRINCIPAL/CLIENT: (Last) (First) (M.I)
3300 Publix Corporate Pkwy. Lakeland
BUSINESS NAME AND ADDRESS (Number and Street) (City)
(863) 688-1188 (863) 284-5532
TELEPHONE NUMBER: FAX NUMBER: (optional)
FL 33811
(State) (Zip Code)
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:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR
MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP
OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Site plan approvals for redevelopment of Publix Supermarket on 69`x' Street and Collins
Avenue
Issue to be lobbied (Describe in detail):
{ M2719679;1 }
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A, Full Name of
Individual/Title B. Any Financial, Familial or
Professional Relationship
City Commission None
Planning Department None
Planning Board, Design Review Board,
Zoning Board of Adjustment None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION
(DISCLOSE WHETHERHOURLY, FLAT RATE OR OTHER):
A. LOBBYIST DISCLOSURE: (Required) $500 00 hourly
B. PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required)
Same
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 ®No: Are you lobbying on a present or pending bid for goods,
equipment or services, or on a present or pending 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 ®No: Are you lobbying on a pending application for a Development
Agreement with the City or application for chance of zoning
map designation or chance to the City's Future Land Use
Map?
(3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those
exempt from the definition of "lobbyist"asset forth in Section 2-481 above)
who only appears as a representative of anot-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 ®No: Are you representing snot-for-profit corporation or entity
without special compensation or reimbursement.
{M2719679;1 } 2
V. SIGNATURE UNDER OATH:
ON OCTOBER 1sT OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY
CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES,
AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE
PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE
HAVE BEEN NO EXPENDITURES OR COMPENSATION ING THE REPORTING
PERIOD. ~ ~/1
Signature of Lobbyist
I do solemnly swear that all of the foregoing
familiar with the provisions contained in Se
reporting requirements.
Signature of Lobbyist:
are true and correct and that I have read or am
a-482 of the Miami Beach City Code and all
Signature of Principal/Client: ~~ r"T~7 ~ C~-
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
`Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF
NOTARY:
State of Florida, County of Miami-Dade
Sworn and subscribed before me
Thi~ day of , 20~
PRINCIPAL IDENTIFICATION:
^ Produced ID,
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This -day of , 20_
.~
Signature of Public Notary -State of F o ida Signature of Public Notary -State of Florida
''~'''~'`~''~~i'fz'~ o signature Notarization of Principal's signature
~t~ Notary Public State of Floritla
Blanca E Fernandez
~` My Commie~lon UD793M17g
~e,n°' Explrea08l26l201~
FOR CLERK'S USE ONLY
Annual Registration fee: ^Yes ^No Amount Paid MCR # Date Paid
Lobbyist Registration Form received and verified by:.
Revised 12/08/04
{M2719679;] } 3
4. COMPENSATED LOBBYTS7:
The City of Miami Beach Code sub-section 11.8-31 requires the disclosure of any individual or group which has
been, or will be, compensated to either speak in favor of or against a pro}ect being presented before any of
the City's Development Review Boards, or not to speak at all, Please list below all persons or entities
encompassed by this section.
NAME ADDRESS RtIOTIE # TO SPEAK N0770
a Nelsen O. Kesdin 1 SE 3rd Ave, 33131 {305) 982 5629 X PRO con SPEAK
b Andrew Frey 1 SE 3rd Ave, 33131 (305) 982 5510 X
c Mark Van Dyke 300 SE 2 St, 33301~~ X
Additional names can be placed an a ~cxpara~e page attached to this farm.
* Disclosure shall not be required of any entity, the equity interest in which are regularly traded .
on an established securities market in the United States or other country, or of any entity, the
ownership interests of which are held in a limited partnership consisting of more than 5,000
separate interests and where na one person or entity holds more than a totaF of 5°!0 of the
ownership interests in the limited partnership.
The applicant, hereby attests that the d'Sdosure information listed on this application ~ a full disclosure oFafl parties of In6erest kt this
application to the Vest of my knowledge and belief.
annli(~nt also herebV,~cknowledaes that anv apgmral aranted by the Board so aanfied to shall be subied m anv and all
conditions imposed by said Board and by arry other Board having turrsdittion and that the proied must also oomph with
the code of the Clty of Miami Beach apd all other perkinant ordinances
PERSON SUBMITTING APPLICATION:
nature
fOZier
Print Hame
SPATE AFFILIATION WITH APPLICANT (i.e. Agent, Architect, Attorney, Contractor, etc.)
863-688-1188
Phone # , y~
S e me this ~.Gda~yof ~ ,The foregoing rttstrument was admawledged before me
b ho has produced l skiendflcatlon andJoris fylmowntome who
_ did/did not take an oath. ~ _
STATE OF FLORIDA
COUNTY OF M~RfBP' ~~
MY COMMISSION F~CPIRES:
NAME
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City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, wv,,w.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fax: 305.673.7254
CityClerk@miamibeachfl.gov
LOBBYIST NAME: ~'~-d S ~-~ ~ ~ ~5 ~ `n
I understand that no later than October 1st of each year, I must file the following
forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
1) Lobbyist Expenditure Form
2) Disclosure Form
Failure to file these forms on 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, once an issue I have registered to lobby on has been resolved, I am required
to immediately notify the f ity Clerk's Office of lobbyist withdrawal in writing.
Signature:
Revisacl o~roazoos
Date: