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Chad Horrell - Erin Lama e cssta MI „� RECEIVED fM E n Office of the City Clerk O C T 17 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 action; decision;Tecommendation-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 -Commiission;ore-City-board or-committee.The-tenn-specifically-includes-the-principal-as-well-as-any-employee-engaged-in lobbying- activities.The term"Lobbyist" 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 cbinplete an answer, use a Separate stieet(s)of-paper.:If-you-have-nothingtoreportina 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'lobbyistihas=a"colntinuing,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:. • Horrell, Chad NAME OF LOBBYIST (Last) (First) (Middle Name) DoorDash, Inc. c/o 28 Liberty Ship Way, Suite 2815, Sausalito, CA 94965 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) - (State) (Zip Code) (415) 903-2800 doordashl@politcomlaw.com - LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS IL PRINCIPAL INFORMATION: Lama, Erin NAME OF PRINCIPAL (Last) (First) (Middle Name) DoorDash, Inc. 303 2nd Street, South Tower, Ste. 800, San Francisco, CA 94107 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (415) 903-2800 doordash@politicomlaw.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS Pursuant to:;City Code ction:2- .82(h)(1)(a) A:pnncipal.of any corpo Se ration partnership;or other entity who appears as:a lobbyist on behalf of,that entity;without compensation orreimbr rsementforthe appearance,whetherdirect,indirect;or contingent;to express support=of oropposition'to an item shall register,with the Clerk as`required`by,this subsection-but shali.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): • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write NIA): Tony Xu • 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): SVF Fast(Cayman) Limited, Entities affiliated with Sequoia Capita, Greenview Investment Pte Ltd.l Page 1 of 5 • 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. Matters affecting app based delivery services • 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 Commissioners & Staff X Mayor & Staff X City Manager& Staff 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): N/A 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): $1,000 per month Page 2 of 5 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 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 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 XNo: 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 es, has it been less than 1,2 onths ince the elected official(s) whom vo provided c.mpalq n trf inq services was sworn ini. 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 2-491) shall disclose such particular service on his/her lobbyist registration form and shall orally disclose such particular 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 within the past election cycle? If yes, please list the incumbent member(s)of the City Commission: Yes XNo:. If yes, ere ou pro ised or did you receive economic consideration in exchange for campaig consuEfiin"'iT'e"rvices,"F -- >11 TO xBE COMPLETED BY CITY CLERK'S STAFF ONLY _""- ` ;kV @t};F 5'* x'ha 4* M1 � `` �` e ' 3.'P+ Q b�.e" �r. P�i 1,0 Registration{ *�f Gb Amount Paid$ MCR# Paid .. = li ai • 1 ^ t . LobbistRe istration received verified ). i- `1ig. 1 ' �A ik!t A r+' ,'.+'��' • g ' : ' Revised 03 11 2020 Page.3 of 5 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_SP-ECIFIC ISSUE ON_WHICH THE LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN'IF THERE HAS BEEN NO EXPENDITURE OR COMPENSATION DURING THE REPORTING PERIOD.' Signature of Lobbyist: ��� Y�'' Date � � 7/ 265 Z 2 • 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 with the provisions contained in Chapter 2, Art. VII, Division 3, entitled"Lobbyists" of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist _ C �� Date °1 2 7l Z. D Z.Z. Signature of Principal: Date /0/-7-/QQ VII. NOTARY SIGNATURE ANDSEAL: LOBBYIST: ' PRINCIPAL State of • \I s sit . State of Ci/1--/PDRA7/4 County of: OVA.X4nJr i County of: l /N Sworn to(or affirmed)and subscribed before me, Sworn to(or affirmed)and subscribed before me, by means of physical presence by means of E 'physical presence or❑ online•notarization, or D online notarization, this 2-7 day of et- ,20zzrby this"day of ©G-tv 8 , 202,by CkAd 1.-(0„ (� �R/N ilaina/ NAME OF LOBBYIST NAME OF PRINCIPAL ✓Produced ID Otcv-ev LcP,,so _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION Personally Known - V Personally Known A,D6: R4e,_ Signature of Notary Public Signature-of Notary lic l�a ef1�c 1%/at ikSCR11`/ Name of Notary, Typed,- ►,ie ar p+ac6.- Name of Notary, Typed, Printed or Stamped t rs,L.,.,,• KATER1NA VALDIVIA Notary Public (NOTARY SEAL) i ' ,;,� , Commonwealth of Virginia I (NOTARY SEAL) 1 av�':,• SHEILA SCALLY My Comm. kxpires 711�'2024 COMM. #2312043 z • re r�,,. Notary Public•California o z3 Marin County V I The term"lobbyist'specifically excludes the following persons: ++-+ Mir Comm.EK�ires Nov.9`2023 i 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:representativ-e-of 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 MIAMI EACH . .„ City of Miami Beach,3700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl:gov - Office of the City Clerk Rafael E.Granado,City Clerk CityClerk@miamibeachfl.gov Tel:305.673.7411, Fax:305.673.7254 • NAME OF LOBBYIST: Ck acksk b r re,l 1 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 1 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 $500.00 pursuant to Section 2-482 of the Miami Beach City Code. 2 7/g P 2'7-- Signature of Lobbyist Date F_1CLER1$ALUaFORMSILOBBYIST FORMS1Lobbyist Registration Forth Revised 03-11-20 REG.doc Page 5 of 5 x 5` Miscellaneous Cash Recei t R p � C 'IOFNIIAMI•BEACH - �a 430763.;' ;: No ❑'Cash 0 Credit Card 'f Check# ;, .:1 , 0;.:;-:::,,;;;;,',74;',:7:,,k'''::-Ati-;:,ti.'",''':.:;v-;'---:', Received of itt . f 20 �' c 1 t Address , :� - ? z F , I t' € t k . , #°. •{ For t� j�-� r� t. • F d t }.' 3.:. i k d R S , MlsCeIjane0!]S l CR 2023 a p. �' i'00574.2-0022 Carmen V. 10/17/2022 D3:03PPJI s '` MCR OPEN(MCR) Payment ounf 850 00 �gx a c. � ��r �� k g �.- - y� - � (THIS INFORMATION MUST BE COMPLETED• i Office of Finance Director Account number: 1 t'` �� ,I L ',B ( a '�:. : 1.' „, Preparer t � : ; • y Dept:: - EXT ��`� � ccx 6�u,' \.Y Vd d 4 ,p. �..L ,: Y5 M T 0