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Teye Kutasi (2)m MIAMIBEACH City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM ~~~~ ~- ~'af ~i, ~ ~~ (~~~ 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 Ordinance 20043435. , ~ ~ _ NAME OF LOBBYIS (Last) (First) ~~r~-~ia~~arfn~~-~ 2~ s (~~~.lr~-n~ c~• BUSINESS NAME AND ADDRESS (Number and Street) (City) TELEPH NE UMBER: NUMBER: I. LOBBYIST RETAINED BY: ~m ,~ ~. ~ NAME OF PRI U IE T: l 3 ~5 ~~rc~~ell ~./e~ f~ i'a~rv;~ MBER: EMAIL: ~rnm Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ~-~,5~~~ ~ e©~ • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II.SPE IC LOBBY ISSUE: /~ ~QY'kYV1 /'Y~!~'IQ E',o'-'1~~,1.7~" ~~U~G~~S Issue to be lobbied (Descri in detail): lll. 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 ~zf ~L~rlmrSS~o ~ ~~~ ~,~ -~;~ ,~ 11 ~ I h ~ZI Wd O 1 ~~iW 600Z -CJ~I 131 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) ~/~ ~ /~~ 2Z ~^, o B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): v (Required). '~i ~ y~~ ~~ 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 lobbving on a present or pending bid for goods, equipment or services, or on a present or pending award for goods. eauipment 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 lobbyiing 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: ON OCTOBER 1sT OF EACH YEAR. EACH LOBBYISTi9~kIALL SUB IT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH LISTING LOBBYING XP TURFS AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE P CE G CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITU COMPENSATION Duel~iG_IHE REPORTING PERIOD. Signature of Lobbyist I do solemnly s r that I f the f regoing facts are true and correct and that I have read or am familiar with the provisions containe in 2-4 of the Miami B e and all reporting requirements. Signature of Lobbyi Signature of Principal/Client: ~- VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification -~ Produced ID Form of Identifica~,~Agy PUBLIC-STATE OF FLORIDA Personally known (Lobbyist) '""' Gregory D. 1VlulliS Personally known (Principal) -CommtssiGn #DD675323 VII. SIGNATURE A F~q,Ip~lO9ALLOSA ',; ~?,-' Expires: JULY 05, 2011 ~,~ '„ MY COMMISSION 11 DD 639713 BONDED THRU ATLAN'1TC BONDING Co., INC, State of Florida, County '. `dBEXPIRES:February22,201t Swor~t~i and subscr' e Bond~'n""~°ryu"~°'"''"°`~ tate of Florida, County of Miami-Dade hi `~"~ d f ~~"'~~'~"' wor and subscribed before me ~ This day of,l-E$t~-x_20 d~'• ~r Sig ture u is Notary -State of Florida ign u e ublic otary - ate of Florida Notarization of Lobbyist's signature Not rization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY ~J Annual Registration fee: [ ]Yes [ ] No Amount Paid 3 MCR ~ . Date Paid / Lobbyist Registration Form received and verified by: /~J7irl_,~,~ F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form 21109.doc Revised 02/11/2009 ~, ~ ~ ~~ k rw*" L ~~ City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Tel: 305.673.741 1 ,Fax: 305.673.7254 CityClerk@miamibeachfl.gov LOBBYIST NAME: I understand that no later than October 1st of each year, I must file the following forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's Office for all active lobbying issues. 1 ~ Lobbyist Expenditure Form 2) Disclosure Form Failure to file these forms on a timely basis will result in my name being transmitted to the Miami-Dade County Commission on Ethics and for code violation evaluation. Ina ition, o ce an issue I have registered to lobby on has been resolved, I am required to i mediate) notify the City Clerk's Office of lobbyist withdrawal in writing. Signatu ~~~ ~ ate: F:ICLERILOBBYIST1Lobbyist Registration Form 3270$.doc