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Janet Bloomberg - Mary Aileen Murphy 6-1 Li) q DocuSign Envelope ID:3751C421-0788-41DA-9487-3E2E00A9DAD2 S RECEIVED 1\A I AI\A I BEACH Office of the City Clerk JUL 22 2022 1700 Convention Center Drive Miami Beach, FL 33139 CITY OF MIAMI BEACH 305.673.7411 OFFICE OF THE CITY CLERK 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 City Code Chapter 2, Article VII, Division 3, entitled "Lobbyists," for additional information. Instructions: Please complete all sections of this form and submit the completed form,with the applicable fee, to the Office of the City Clerk. If you need more space to complete an answer, use a separate sheet(s)of paper. If you have nothing to report in a particular section, you must write "none" or "n/a" in that section. Any change to any information originally filed, or any additional City Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amendment to the registration form. The lobbyist has a continuing duty to supply information and amend the forms filed throughout the period that the lobbying occurs. Separate registration forms shall be required for each principal represented on each specific issue. I. LOBBYIST INFORMATION: Bloomberg Janet NAME OF LOBBYIST (Last) (First) (Middle Name) KUBE Architecture, 818 18th Street NW, Suite 600, Washington, DC 20006 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 202-986-0573 janet@kube-arch.corn LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Murphy Mary Aileen NAME OF PRINCIPAL (Last) (First) (Middle Name) 2812 29th PL NW, Washington, DC 20008 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 5 708-205-0980 Ma ry @LJMDevelopment.corn • PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS Pursuant to City Code Section 2-482(h)(1)(a): A principal of any corporation, partnership, or other entity who appears as a lobbyist on behalf of that • entity,without special compensation or reimbursement for the appearance,whether direct,indirect,or contingent,to express support of or opposition to • an item shall register with the Clerk as required by this subsection but shall not be required to pay any registration fees. • If the principal is a Corporation, Partnership or Trust, the following information MUST be provided pursuant to City Code Section 2-482(c): m . NAME OF CHIEF OFFICER, PARTNER,OR BENEFICIARY(if none,write N/A): N/A S • NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST(if none,write N/A): N/A LL Page 1 of 5 ' doocVerify ID. erify.00m83F43.5FAB-42F4-AE33-2B02A935B4CD Page 1 of 5 12B02A935B4CD ,III 'I III DocuSign Envelope ID:3751C421-0788-41DA-9487-3E2E00A9DAD2 III. ISSUE TO BE LOBBIED: Describe 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. Development approvals and permitting issues, including, but not limited to the Historic Preservation Board, Design Review Board, Planning Board, Board of Adjustment, Land Use and Sustainability Committee, City Commission, any City Workshops or Committees, and City Departments, if necessary relating to the property located at 621 West 44th Street, Miami Beach, Florida. IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(a)(4), list the City Commissioner or City personnel sought to be lobbied, and whether the lobbyist has entered into any contractual 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 Contractual Relationship (If yes, explain) YES NO Title of Person to be Lobbied Staff for the Planning Department, Building Department None. X Public Works, and City Administration, PB, HPB, BOA None. X • DRB, City Commission, and Mayor as necessary None. 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 appearance of impropriety(if none,write N/A): None. 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): $190/hour Page 2 of 5 DDocVercver ID: 6D6B3F43-SFAS-42F4-AE33-2B02A93564CD Page 2 of 5 22B02A935B4CD 1111 �4SC:�r1 'I II I DocuSign Envelope ID:3751C421-0788-41DA-9487-3E2E00A9DAD2 The following six(6)questions MUST be answered: 1) Pursuant to City Code Section 2-488, entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": _Yes XNo: Are you Iobbyinq 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 City Code Section 2-490, entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": —Yes XNo: Are you lobbying on a pending application for a Development Agreement with the City or application for change of zoning map designation or change to the City's Future Land Use Map? 3) Pursuant to City Code Section 2-482(h), any person (except those exempt from the definition of "lobbyist" as set forth in Section 2-481)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 city clerk as required by this section, but shall not be required to pay any registration fees. _Yes X_No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement? 4) Pursuant to City Code Section 2-481, the term "lobbyist" specifically excludes the following persons: Expert witnesses who provide only scientific,technical or other specialized information or testimony in public meetings; any person who only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether direct, indirect or contingent,to express support of or opposition to any item; and any person who only appears as a representative of not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for the appearance. _Yes XNo: Are you providing only scientific, technical or other specialized information; appearing as a representative of a neighborhood association without special compensation or reimbursement or representing a not-for-profit based organization for the purpose of requesting a grant without special compensation or reimbursement? 5) Pursuant to City Code Section 2-491(1), no campaign consultant shall lobby the City Commission for a period of 12 months following the swearing in of any elected official(s)for whom the campaign consultant provided campaign consulting services within the past election cycle. See Section 2-491 for more information. —Yes ANo: Have you provided campaign consulting services to an incumbent member of the City Commission within the past election cycle?If yes,please list the incumbent member(s)of the City Commission: _Yes_XNo: If yes, has it been less than 12 months since the elected official(s) whom you provided campaign consulting services was sworn in? 6) Pursuant to City Code Section 2-482(a)(4)a., a lobbyist who has within the past election cycle provided campaign consulting services to an incumbent member of the City Commission (which lobbying activity is not otherwise prohibited by Code section O 2-491) shall disclose such particular service on his/her lobbyist registration form and shall orally disclose such particular h service before lobbying the City Commission at a public meeting. Yes XNo: Have you provided campaign consulting services to an incumbent member of the City Commission — 0 within the past election cycle?If yes, please list the incumbent member(s)of the City Commission: 0 Yes XNo: If yes, were you promised or did you receive economic consideration in exchange for campaign N consulting services? 0 m w TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: >qces[ ]No Amount Paid$ UcJ.-- MCR# 3 w F� ? Date Paid '7 � s "' 06 a �74 Lobbyist Registration Form received and verified by: J , F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration orm Revised 09-20-18 REG. Revised 09/20/2018 o Page 3 of 5 DocVerify erID: 6Dom63F43-5FA6-42F4-AE33-2602A93584CD Page3of5 _ 32802A93584CD ,III M 'IIII DocuSign Envelope ID:3751 C421-0788-41 DA-9487-3E2E00A9DAD2 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 LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, FOR THE 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 COreNS Y1',fION pURING THE REPORTING PERIOD.' r;11)eal rfi. 7/14/2022 Signature of Lobbyist: 1FD059D815,:P416 Date I do solemnly swear or affirm that all of the foregoing facts, statements, and disclosures in this form are true and correct, and that I have read or am familiar. o I with the the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of the Miami Beach City C ehan8. if i ID O4t Art)requirements. AM 7/14/2022 Signature of Lobbyist: U660s14)50515y1416 Date � � � 7/14/2022 Signature of Principal: 1 8E4,e aresBSA�acs� Date VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of Florida State of Florida County of: Miami Dade County of: Miami-Dade Sworn to (or affirmed)and subscribed before me, Sworn to (or affirmed) and subscribed before me, by means of❑ physical presence by means of 0 physical presence or Xonline notarization, or Xonline notarization, this 14th day of July ,20 2.2by this 14th day of July ,20 2.by Janet Bloomberg Mary Aileen Murphy NAME OF LOBBYIST NAME OF PRINCIPAL Produced ID Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION X Personally Known, X Personally Known O'y Signature of Notary Public Signature of Notary Public Betty Llerena Betty Llerena Name of N - - - - - - - Name of Not Pd_2rint�rY. Betty Llerena Betty Llerena Commission#HH 221018 Commission#HH 221018 (NOTARY (NOTARY S Notary Public-State of Florida Notary Public-State of Florida My Commission Expires Mar 05,2026 My Commission Expires Mar 05,2026 0 m - _ • 1 The term"lobbyit.:,1—;=7. Z; n Expert witnesses who provide only scientific,technical or other specialized information or testimony in public meetings; any person who • only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance, whether direct, indirect or contingent, to express support of or opposition to any item; and any person who only appears as a representative of LL not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for • the appearance. Page 4 of 5 ' DocVerifyID:6D6B3F43.5FA8-42F4-AE33-2B02A935B4CD �Page 4 of 5 42802A935B4CD ti.> www.docverify.com 'III +: 'III , DocuSign Envelope ID:3751 C421-0788-41 DA-9487-3E2E00A9DAD2 MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov Office of the City Clerk Rafael E. Granada, City Clerk CityClerk@miamibeachfl.gov Tel: 305.673.7411, Fax: 305.673.7254 NAME OF LOBBYIST: Janet Bloomberg 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 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 30th of each year, shall be automatically 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 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 $500.00 pursuant to Section 2-482 of the Miami Beach City Code. ,—DocIISignedd by. Jam+ f7thamtecl 7/14/2022 cs, '' 1FD059D815CA416 Signature of Lobbyist Date LL LL 2 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc LL r0 Page 5 of 5 IDocVerify ID:6D6B3F43.5FA8.42F4-AE33-2B02A935B4CD vdww.docverify.com Page 5 of 5 52802A935B4CD 'III 1I II i .2 U BHall 7.3 ii-r, i 0 x • City at 41 '` ' - 10 1700 Convention Center Dr. 3 I: Miami Beach , FL 33139 11 305-673-7420 n1 — Welcome J t. F m c) F 005599-0013 Adrian V. 07/21/2022 12:05PM co MISCELLANEOUS r m Reference 1: MCR430066 m '' [] MCR OPEN (NCR) -` 2022 Item: NCR 1 N 1,200.00 7- NCR OPEN (NCR) 1 ,200.00 ; -,.. __ 1,200.0o �' Suhtutal 1,200.00 ` Total 1,200.00 ,,,t....N.,z, CHECK 1 ,200.00 ad Check Number12U8 Change due 0.00 h a Paid by: UN DEVELOPMENT, (.(-C ` _.; o CD 11111IIIIIIIEIIIIiiIIIIIIIIMIIIN'dIMIIIIIII III IV wtimm 'AN"like 6 r aP Kam, &ail_ .. ,$ b.iaa,oo LaAi,l 1110' ru -� �- r�tnb4. f Be�,.�mahcb Thank you for your payment CUSTOMER COPY A � O docv'erify , . ..;3, , O�CVER�� Lobbyist-Registration-Form JB Signed.pdf DocVerify ID: 6D6B3F43-5FA8-42F4-AE33-2B02A935B4CD Created: July 14, 2022 13:07:29 -8:00 Pages: 5 Electronic Notary: Yes / State: FL This document is a DocVerify VeriVaulted protected version of the document named above. It was created by a notary or on the behalf of a notary,and it is also a DocVerify E-Sign document.which means this document was created for the purposes of Electronic Signatures and.or Electronic Notary.Tampered or altered documents can be easily verified and validated with the DocVerify veriCheck system. Go to www.docverify.com at any time to verify or validate the authenticity and integrity of this or any other DocVerify VeriVaulted document. E-Signature Summary E-Signature Notary: Betty Llerena(BLI) July 14,2022 13 09 30-8:00[E14B4D7FBC1B][162.244.152.118] bllerena@brzoninglaw.com 11 11r1 rpry 11111111111111111111111111111111111111111111111111111111111310 DocVerify documents cannot be altered or tampered with in any way once they are protected by the DocVerify VeriVault System.Best viewed with Adobe Reader or Adobe Acrobat. All visible electronic signatures contained in this document are symbolic representations of the persons signature,and not intended to be an accurate depiction of the persons actual signature as defined by various Acts and/or Laws. DocVerify ID:6D6B3F43-5FA8-42F4-AE33-2602A935B4CD ,III r: 'I II Generated Cover Page 2B02A935B4CD www.docverify.com MIAMI BEACH RECEIVED City of Miami Beach 1700 Convention Center Drive JUL 21 2022 Miami Beach, Florida 33139 www.miamibeachfl.gov CITY Cr MIAMI BEACH City Clerk's Office oFFice ,,I-_LI-IF CITY CLERK Tel: 305-673-7411 Fax: 305-673-7254 Office Use Only ANNUAL LOBBYIST REGISTRATION FORM Name: Janet Bloomberg Business Name: KUBE Architecture Address: 818 18th Street NW, Washington, DC 20006 Office Telephone Number: 202-986-0573 Cellular Telephone Number: Email Address: janet @cube-arch.corn If more than one lobbyist, please list: 1) 2) 3) 4) 5) 6) 7) Submit this form to the Office of the City Clerk, along with a check for $500 for each lobbyist. Please make the check(s) payable to the City of Miami Beach. For City Clerk's Office Use Only MCR#: ��0L/����))(O c Amount paid: 560` O 0 Date paid: Processed by: �/0/`-' s � Date: L/ F\CLER\SALL\aFORMS\LOBBYIST FORMSWNNUAL LOBBYIST REGISTRATION FORM reg.docx