Robert Martin Moehring - Michael Scott A25 N.) 6fcx-s Dr
,
RECEWM AM I Office of the City Clerk
1700 Convention Center Drive T -3 2022
Miami Beach, FL 33139
305.673.7411 CITY OF MIAMI BEACH
LOBBYIST REGISTRATION FORM OFFICE OF THE CITY CLERK
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 "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 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:
Moehring Robert Martin
NAME OF LOBBYIST (Last) (First) (Middle Name)
DOMO 420 Lincoln Road, Suite 506 Miami Beach Florida 33139
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-674-8031 305-984-3624 robert@domodesignstudio.com
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION: id?cud 5064
North Hibiscus California MS LLC•
NAME OF PRINCIPAL (Last) (First) (Middle Name)
North Hibiscus California MS LLC 320 N. Park Vista Street Anaheim California 92806
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
310-860-8956 310-497-6677 michaelhscott@michaelhscott.com
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
Pursuant to City Code Section.2-482(fi)(1)(a):.A principal of eny 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.thissubsection but_shall nat be'reguired 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 N/A): Michael Scott
• 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): See Exhibit attached
N/A
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.
Development approvals and permitting issues, including but not limited to the Historic Preservation
Board, Design Review Board, Planning Board, Board of Adjustment, Land Use Development, City
Commission, and any City Workshops or Committees, if necessary, relating to the property located
at 225 N Hibiscus Drive in 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 & Building Department, None X
Public Works & City Administration, None x
Planning Board, Historic Preservation Board, None X
Board of Adjustment, Design Review Board, None X
City Commission, and Mayor as necessary. None X
N/A N/A N/A N/A
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 anj/ Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an
appearance of impropriety(if none,write N/A):
None
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):
$250/hr
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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 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 City Code Section 2-490, entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development
Issues":
_YesX_No: 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.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 No: 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:
N/A
Yes No: If yes, has it been less than 12 months since the elected official(s) whom you provided campaign
consulting.serviceswas 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
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 No: 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:
N/A •
YesX No: If yes, were you_promised or did you-receive economic consideration in exchange for campaign
consulting services?
TO BE COMPLETEDC BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ filo Amount Paid$ J0�a� MCR# ���J 3 o� Date Paid [�)-2 Z
Lobbyist Registration'Form received andverified by:
F;\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revise 03-11-20 REG.doc 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 SPECIFIC 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.'
gAt Signature of Lobbyist: Date 09/23/2022
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: Date 09/23/2022
Signature of Principal: Date 09/29/2022
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of Florida State of Texas
Seminole Brazoria
County of: County of: _
Sworn to (or affirmed) and subscribed before me, Sworn to (or affirmed)and subscribed before me,
by means of❑ physical presence by means of❑ physical presence
or eallirjp notarization, September or i�'online notarization,
this day of p , 2022, by this29th day of September , 2®22, by
Robert Martin Moehring Michael Hume Scott
NAME OF LOBBYIST NAME OF PRINCIPAL
Produced ID DRIVER LICENSE "Produced ID DRIVER LICENSE
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
_Personally Know _Personally Known
a),jia, • erg))jr_
Signature of Notary Public Signature of Notary Public
Brandon Coleman Notary Public,State of Texas
Otis Irvin Cobb, II
Name of Notary,Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped
Commission ID:132750156 a,AIlIIR1lr,,,,
��`I rllllllf �i� BRANDON COLEMAN
(NOTARY SEAL) SEAL)
Otis Irvin Cobb,II
t0 Notary
0
Notary Public-State of Florida (NOTARY S EAL) r 1�
•!..`/\� '- ID NUMBER
IIIIII Commission Expires: 10/27/2024 '" 13175015E
` Commission b MH 2e66&5 �'3y�t@'o {6, COMMISSION EXPIRES
���'�A`4 R Expires on March 19,1026 *4%,/fi IOI00 October 27,2014
1 The term"lobbyist"specifically excludes the following persons: Notarized online using audio-video communication
Notarized online using audio-video communication
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.
Page 4 of 5
AA AM
j
City of Miami Beach, 1700 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: Robert Moehring
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.
09/23/2022
Signature of Lobbyist Date
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc
Page 5 of 5
Page 4 of
OWNER AFFIDAVIT FOR INDIVIDUAL OWNER
STATE OF
COUNTY OF
I, , being first duly sworn, depose and certify as follows: (1) I am the owner of
the property that is the subject of this application. (2) This application and all information submitted in support of this
application, including sketches, data, and other supplementary materials, are true and correct to the best of my knowledge
and belief. (3) I acknowledge and agree that, before this application may be publicly noticed and heard by a land
development board, the application must be complete and all information submitted in support thereof must be accurate. (4)
I also hereby authorize the City of Miami Beach to enter my property for the sole purpose of posting a Notice of Public
Hearing on my property, as required by law. (5) I am responsible for remove this notice after the date of the hearing.
SIGNATURE
Sworn to and subscribed before me this _ day of , 20 . The foregoing instrument was
acknowledged before me by , who has produced as
identification and/or is personally known to me and who did/did not take an oath.
NOTARY SEAL OR STAMP
NOTARY PUBLIC
My Commission Expires:
PRINT NAME
ALTERNATE OWNER AFFIDAVIT FOR CORPORATION, PARTNERSHIP OR LIMITED LIABILITY COMPANY
STATE OF California
COUNTYnA OF Los Angeles
IY`I, ickutt Soya. , being first duly sworn, depose and certify as follows: (1) I am the
CMindr/rnur►agt►uj it cmlo-cr (print title) oflslotrt-h 1litalSlus Calthhrnl4%U. (print name of corporate entity). (2) I am
authorized to file this application on behalf of such entity. (3)This application and all information submitted in support of this
application, including sketches, data, and other supplementary materials, are true and correct to the best of my knowledge
and belief. (4) The corporate entity named herein is the owner of the property that is the subject of this application. (5) I
acknowledge and agree that, before this application may be publicly noticed and heard by a land development board, the
application must be complete and all information submitted in support thereof must be accurate. (6) I also hereby authorize
the City of Miami Beach to enter my property For the sole purpose of posting a Notice of Public Hearing on my property, as
required by law. (7) I am responsible for remove this notice after the date of the hearing.
SIGNATURE
Sworn to and subscribed before me this day of , 20 . The Foregoing instrument was
acknowledged before me by , who has produced as
identification and/or is personally known to me and who did/did not take an oath.
NOTARY SEAL OR STAMP
NOTARY PUBLIC
My Commission Expires:
PRINT NAME
We are committed to providing excellent public service and safety to oll who live,work,and ploy in our vibrant,tropical,historic community.
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate
is attached, and not the truthfulness, accuracy, or
validity of that document.
State of Cali ornia t rw,�2,
County of s-r U
Subscribed an sworn to (or-affirmed-}before e on/this
day of , 20 22 by 11 i(Ra-2l
proved to me on the basis of satisfactory evidence to be the
personks`)who appeared before me.
NGUYEN—
$1 ``+wi, COMM. #2356099 z
3A Notary Public.California o
z 57, Orange County
1 . My Comm.Expires Air.29,2025 t
(Seal) Signature
1
Page 6 of 8
DISCLOSURE 0 INTEREST
CORPORATION, PARTNERSHIP OR LIMITED UARILITY COMPANY
If the property that is the subject of the application is owned or leased by a corporation, partnership or limited liability
company, list ALL of the owners, shareholders, partners, managers and/or members, and the percentage of ownership held
by each. If the owners consist of one or more corporations, partnerships, trusts, partnerships or other corporate entities, the
applicant shall further disclose the identity of the individual(s) (natural persons) having the ultimate ownership interest in the
entity.
Worth il(hlscuw Oatlfomic4 L-Lc
NAME OF CORPORATE ENTITY
NAME AND ADDRESS OF OWNERSHIP
Midifit6 SICIA 320 I' PG1Yk V1S Ir Argiheltri GA 50%
61250
(Leon Pc ci° kkystA p shtac_ 5-0,0/o
100 CG l5 CDNi . c va sok. tlool
tAcam% Ft 33132
NAME OF CORPORATE ENTITY
NAME AND ADDRESS %OF OWNERSHIP
•
If there are additional corporate owners, list such owners, including corporate name and the name, address and percentage
of ownership of each additional owner, on a separate page.
We are committed to providing excellent public service and safety to oil who Jive,work,and play in our vibrant,tropical,historic community.
Miscellaneous Cash Receipt
CITY OF MIAMI BEACH ,
❑Ca No 430532,
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Recerved'.of ` f .. K3s
Address _: 4 ti
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