Tachmes, Alexander I.~ E b '<'s ~.r ,
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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 mddificati~^pf ' ,.-~
any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the City Manager or any r~ty,• boar~'rh
committee; or any action, decision or recommendation of any city personnel during the time period of the entire decision-making procgs~ on s~ "f
action, decision or recommendation that foreseeably will be heard or reviewed by the city commission, or a city board or committee. (tithe terms- ,,.~%
specifically includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions^''Please
refer to Ordinance 20043435. ~- ~ ~.~
~j:
"~A-C. H rY1 ~S ~ Lt~~tN~t~ ~ • Tt ~
NAME OF LOBBYIST: (Last) (First) (M.I) _,-, ~
BUSINESS NAME AND ADDRESS
~d 5 -3~f `1- `13 `~
TELEPHONE NUMBER:
I. LOBBYIST RETAINED BY:
LAP aoI S. ~~
(Number and Street)
- 3 ~I `7 -~1 `7 S~/
CpM
NnAME OF PRINCIPAUCLIENT:
i-tMER~c~~ `Trf~ ~ c~f~ ~o Lu r~olvs .fir. 7~ 81 ~', GItA412il . S~o`t1 s~A-c.E AZ S~
BU
(Number and Street)
(Zip Code)
(State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a
p or Trust [Section 2-482
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ~~~ $ ~U~t1 r 1 ,2°51 ~- ~D
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
u.SPECIFIC LOBBY ISSUE:
Issue to
in detail):
ul. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(g) include
a statement of the extent of any business, financial, familial, professional or other relationship, giving rise 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 said City
personnels' commencement of service with the City to the present date, stating the general nature of the subject
contractual relation.
A Full Name of Individual Title B) An Financial, Familial or Professional Relationship
CI t My1^tSS101u ~C
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t CEn~r1~ I T~-S
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ~ ~O
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ~ ~'SO'
~s__..~._~~
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 change of zoning map designation or change to the CitV'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" as set forth in Section 2-481 above) who only appears as a representative of snot-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 anot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
signature or Loo~yist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the
provisions contained in Sectiory2~4~ of the Miami Be c Ci~Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
^ Produced ID ~ ~ iO °
Form of Identific~ o N o
~n
Personally known (Lobbyist) o ~ Q'-' b
u., r~'~ Cra o
VII. SIGNATURE AND STAMP OF N0~1~(:o w p
~,:y .. ~~
State of Florida, County of Miami-Dade ~ •~ ~ ~?
Sworn to and subscribed before me
This /q-~ day of ~e ~ ~~ r , 2009 a ~ ~ ~~
' ,>- ,~
G~c~-~ ~._ -cam ~~
Signature o ublic No ry -State of Floridan ~,
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
~ Produced ID
Form of Identification
^ Personally known (Principal)
>QRiZONA }~121UD q.
State of f~lerida, County of '
Sworn and subscribed before me
This day of , 2009
Signature of Public Notary -State of Florida
Notarization of Principal's signature
BY
STAFF
Annual Registration fee: [ ]Yes [ VjNo Amount Paid 5~~ CR 1_ ~ / Date Paid rT~
Lobbyist Registration Form received and verified by: ~.
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form 21109.doc Revised 02/11/20U9
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Rsqulred) ~ 5th ~ ~ r
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ~ X50
The following information must bs answered:
1) Pursuant to Miami Beach City Code Section 2.48r, Entitled "Prohibited Campaign Contributions ey Lobbyists
On Procurement Issues":
Yes ^ No: Are you tobbving on a present or pending bid for goods. eguloment or services. or on a
uresent or pending award for goods. eguigment 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 tobbvina on a pending aoolicatlon for a Development Agreement with the City or
aoolicatton for change of zoning map designation or chance to the Ckv's Future Land Use
Ma°?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person {except those exempt from the definition of
"bbbyisY as set forth in Sectbn 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 opposlUon to any item, shall register with the dark as required by this
section but, shall not be required to pay any registration fees.
^ Yes ~NO: Are you regresent(ng knot-for-profit corporation or entity without scecial compensation or
reimbureement. .
810NATURE UNDER OATH:
Signature of lobbyist:
Signature of PrindpaVCllent:
VI. LOBBYIST IDENTIFICATION:
^ Produced ID d ~ ~ c ~~~,'
Form of kientifl ~ N -
~~ N~~
Personally known (Lobbyist) "~ ~ q ~" e
o ~~
VII. SIGNATURE AND STAMP OF NOf:o ~ °$
~y ..
State of Fbrida, County ofMiami-Dade ~ •~
Swom to and subscribed before me
This 19'~ day of r 2009 ~ ~ ~ ~~
Signature o ublic N - State ~ Fbrida ~
Notarization of Lo bviis~r , is signature
PRINCIPAL IDENTIFICATION: *~..a:.~.~.a.~--
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^ ProducedlD ~ U ~ ~ N
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Form of Identification ~
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~~ Personally known (Principan -~
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State of fteride, County of z ~
Swom a subscri fore me 8
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Sig lure of Pubflc Notary -State of Florida 4
Notarization Of PP lncicicai's signature ~~NatlhhV
TO Bt? COMPLETED BY CITY CLERK'S STAFF ONLY
Annual R~pisb~atlon Ise: ( j Yos [ [ No Amount Pakt i MCR t Dab Pald
Lobbyist Rspistratlon Form reeeiwd and wrMed by:
F:\GLER\>jALL\aFORMS\LOeaYIST rORMS\Lobbyist Ragrstration Form 21109.dot Revised 02/11/2009
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the
provisbns contained fn Sediory~4r~ of the Miami Bg~CitY Code and all reporting requirements.
m P~-'nA~116EACH
City of Miami Beach, 1700 Convention Center Drive, Miomi Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk@miamibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: ~ I~C~G~hlO'~L ~ ' ~~~ ~~
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
2J 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.
~~ zI~ o
Signature: Date:
F:ICLERILOBBYIST1Lobbyist Registration Form 32708.doc