Peter Luukko/Frank Russo/Global Spectrum RFP 20-07/08P i
m ~~,IAPJ~IBEACN
City of Miami Beach Office of the City Clerk 248 $EP -5 PM 4~ 30
1700 Convention Center Drive, Miami Beach, FL 33139 C! T Y C L E ~~ r t' S 0 ~ F` i C f.:
LOBBYIST REGISTRATION FORM
Lobbyist means all persons empbyed 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; eny action, decision, racommendatlan of the City Manager or any cky 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 loreseeably 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 !n lobbying activities. The term "Lobbyists" has specific exclusions. Please
refer to Ordinance 2004-3435.
Zoo `17o~.1A ~-l
NAME OF LOBBYIST: I
~ttiu~ ~~trd ~ tS tt
B_lJ$1NESS N~ JA`M AND, ~DDR,E,S,S
TELEPHONE NUMBER:
I. LOBBYIST RETAINED BY:
Ul~~ gw4e.~ C
NAME OF PRINCIPAUCLIENT:
BUSINESS NAME AND ADDRESS _ _
(Zip Code)
. cep.
~l i~_
~. X135
(Zi~ ode) i~nn,L~
. ~'~+
• (Nu er and Stre~) (CI„ ty) iJn •
306'- 5'58-~- (o70O
FAX NUMBER:
tkatu~'t~ ~+F / u lsct~Q-..
tam u~t~,t~ ~ .1-(.~,~
out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST' IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
u,SPEGfFIC LOBBY ISSUE: 1
` ~, ~o r 14 ~, ci •-z7~-r
Issue to be lobbied (Describe in detail):
nl. CITY AGENCIES/INDIVI,DUALS TO BE LOBBIED: (Pursuant to city code section 2-as2(g)
Include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise to an
appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2-
482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the
commencement of service of City personnel to be lobbied.)
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER): ~ I^'
A) LOBBYIST DISCLOSURE: (Required) , t , _ ~ (~ y~_ i/, ,
B) PRINCIPAL'S DISCI~RU`E tQ~ LOBBYIST CO]v1PEN$A~-IQON~:,~~ ~~ ; ~~ /-~~^ y
(Required). ~(~L. _ I(/K~ -(;'1~'t 1~/ y ~ l ~-(i
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 1SI N0' Are you lobbying on a present or pending bid for aoods, equipment or services. or on a
T 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":
application for change of zoning map designation or chanae to the Citv's Future Land Use
Map?
3) Pursuant to Miami Beach City Cade 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 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. .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of Principal/Client: ~OrnR ZeJIM,D
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
--~-
t~Personally known (Lobbyist
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ~ f ~ , 2008
i~rq Sf Notary -State of Florida
c~j~~~,~'s signature
w
PRINCIPAL IDENTIFICATION:
~ Produced ID
g~
Form of Identification
^ Persona'lly known (Principal) a,,,
•~ ;°~~ DEBRA tl SCFIWARTZ
,~ ~ * MY (MISSION ~ DD 8139xi
,~ EXPIRES: 9, 2012
State of Florida, County of Miami-Da~~.dt~ BondedihNBud~etNoWY3N~bet
Sworn and subscribed before me
This ~~day of ; 2008
Signature of Public ota -State of Flori
Notarization of Principal's signature
°"~'"~ °OF"""'°' "'• """ TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Pa MCR # Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\Lt768YI5"r\Lobbyist Registration Form 327o8.doc Revised 03/27/2008
I do solemnly swear tha of the foregoing facts are true and correct and that I have read or am familiar with the
provisions containe Sectio -482 of the Mean 'Beach City Code and all reporting requirements.
~y~f~~ 1 ~~~~~~~ ~I ~~~
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miami6eachfl.gov
CITY CLERK Office CiiyClerk@miamibeachfl.gov
Tel: 305.673.7411 ,Fax; 305.673.7254
LOBBYIST NAME < <~~~
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 City Clerk's Office of lobbyist withdrawal in writing.
~~
e: D te:
F:\CLER\LOBBYIST\Lobbyist Registration Form 3270t1.doc
..
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, anSOanctel dur n the tie per od of ~heoentire drecision-mak ng process onasuch
9
committee; or any action, decision or recommendation of any city Pe
sdpecifically occludes the princ palLas welltas j~ny employell~`+en h ged inrlobbying activities cc h tmmis Lobbyistscc hasospecifi cA xclus onsThPlea e
refer to Ordinance 2004.3435. {~ ,) ~ C~~j ~ ~~ /
. ~ ~ ` f `//~ .//J
TELEPHONE NUMBER:
i, LOBBYIST R/^ETAINED B ,
~ ~/
NAME OF PRINCIPAUCLIENT:
BUSINESS NAME AND ADDRESS
TELEPHONE NUMBER:
Fill out this section if principal is a
Partnership or Trust
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
~ ~ y~
Cod.- ~
EMAIL: C~,~ ~ f
(State) (Zip Cod
EMAIL: (Optional)
2-482 (c)]
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
n.SPECIFIC LOBBY SSU ~ ~ ~~~,
G~
~ ~~
issue to be lobbied (Descri in detail): ~ //~~~.., 6 7 ~ ~
Ili. CITY AGENCIES/INDIVIDUALS TO BE LOBB D: (Pursuant to City Code Section 2-a62(g)
include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise to an
appearance of an impropriety, with any City personnel sought to be aodbbord.unpaid) ~ from u 12 monthsCPrecede n9 the
482(a)(4) include a statement of any contractual relationship (p
_______. _~ _.....:..e .,r ctw ~x±rsonnel to be lobbied.)
(Last) , ~ ) (M.I)
~1 ~~ r~~
(Number andrStree~ (~Cjity) `~y / (State)
'~) ~,! l/
FAX
f~/~~~
t (,rte
and
,,4
A) LOBBYIST DISC
B) PRINCIPAL'S ¢FSCI~OSURE (OF~LOBB~'f
(Required).- J C / ,, , J ,,
~'
The following information must be answered:
~) Pursuant to Miami Beach City Code Section 2~g8 Entitled "Prohibited Campaign Contributions B
On Procurement Issues":
y Lobbyists
' resent or endin award for oods e,~ui, ment or serv de?e ui rr-ent or services or on a
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobb ist
Real Estate Development Issues":
y s On
V• SIGNATURE UNDER OATk:
- --• ~~~~~~~ ma aesi nation or chap a to the Ci 's Future Land Use r
3) Pursuant to Miami Beach City Code 2-484 h An
"lobbyist" as set forth in Section 2-481 above) who onlsoa (except those exempt from the definition of
corporation or entity without special compensation or reimbu sement for the aresentative of anot-for-profit
indirect, to express support of or opposition to any item, shall register with the clerk as required b this
section but, shall not be required to pay any registration fees, ppearance, whether direct, or
Y
reimbursement. .
Signature of Principal/Client:
~• LOBBYIST IDErN~~IFICATION: ~
-L~I Produced ID a.l~ ~C>> (~
Form of Identification
^ Personally known
VII• SIGNATURE AND STAMP
State of Florida, County of Miami-Dade
Sworn to and subscribed before me ~ ~°~~
This ~{'~day of (~~~__ I _..-2008 ~ N N~
%~y
ig ature of P lic Nota g ~ ~ ~
ry -State f Florida 7 0 ~~
Notarization of Lobs signature ~~
Annual Re TO BE COMPL
9istration fee: [ ~-j'YeS [ ~ No gmount Paid
Lobbyist Registration Form received and verified by:
FF:\C.~ATL\Form;;~obbp,.:aR~~.._.~.,c~,,, c,. ...
. nr•:
rKINCIPAL IDENTIFICATION:
~ y'Produced ID
Form of Identif
^ Personally known
..... ?ice
~
o Fc
~~
State of Florida, County of Miami-D ~~~ ~s~
~
Sw
~
orn and subscribed before me
This ~~la
f y~2 4 o
G~,
°
y o
2008 .~ ~~
~ a~'
~
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.
„~ • G cJO ,r
,
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'a
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i
g ature of Pu is Nota ~
ry -State of lorida ~
Notarization of Pri
i
o
n~
oal_s signatur e /
CITY CLERK'S STAFF ONLY
~ 1 i/ ..
--~-,.~_ CR # Date Paid /
,N`'~/ Revised 03/27/2pnpg/p l~'/
~ `-"'l./
i ao soiemnfy swear that all of the fore oin fa ~ v
provisions contained in Section 2-482 oft
9 9 are true and correct and that I have read or am familiar with the
i Be//~~ij/ y Code and all reporting requirements.
Signature of Lobbyist:
V
y
F 1; P~ ~'~ q r ~
~ f{ ~ '
pJ
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office. CiyClerk@miamibeachfl.gov
Tel: 305.673.741 1 , -Fax: 305.673.7254
~~ ~ V L~
LOBBYIST NAME: ~%'
I understand that no later than October 1st of each ,dear, 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 J 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 regi
to immediately notify the,City Clerk's,
Signature:
to lobby on has been resolved, f am required
of lobbyist withdrawal in,writing.
~ J.z ~ ~
Date:
l~s~vis2d 02;0412008
~~ ~ ,.
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