Johnson, Christopher K.r ~ ~s
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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 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. n
NAME OF LOBBYIST' (Last) (First) \.
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BUSINESS NAME AND ADDRESS
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TELEPHONE NUMBER:
I• LOBBYIST RETAINED BY:
rvHnnt Ul- PRINCIPAUCLIE1IT:
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BUSINESS NAME AND ADDRE~
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~nct[`I NI ~e....:
(Number and Street) (City)
FAX NUMBER:
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(Number and Street) (City)
FAX NUMBER: (Optional)
Fill out this section if principal is a Corporation, Partnership or Tru
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
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(State) (Zip
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
n.SPECIFIC LOBBY ISSUE.
Issue to be
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ul. CITY AGENCIES/INDfVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(8) 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.
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33131 ion
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required).
The following information must be answered:
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1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^ Yes o: Are ou lobb 'n on a resent or endin bid for oods a ui ment or services or on a
present or pendina 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 ou lobb in on a endin a lication for a Develo ment A reement with the Cit or
a lication for chanae of zoning map designation or chanae 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 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 ~Alo Are you representing snot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1sT OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
_ __ _ _ _.. ..,.~..... ~ .~.nnv~w~n rv~c~n~T~ ~RFS DS WELL AS COMPENSATION
PERIOD.
Signature of Lobbyist
I do solemnly swear that all of the forec
provislons~cdr-tained in Section -482
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
roduced ID a~
Form of
^ Personally knovtrn (Lobbyist)
are true and correct and tha ~I have read or am familiar with the
the Miam' Beach City Code and all~rep ``ing requirements.
VII. SIGNATURE AND STAMP OF
State of Florida, County of Miami-Dade
Sworn t~~and.subscribe~d"b~e~for~e me
This /7S JL~` day 9f ~'~"".~-, 2009
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PRINCIPAL IDENTIFICATION:
.5 roduced ID ~~ ~ ~
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Form of Identificat'on ^
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"~ a State of Florida, County of Miami-Dade ~
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~'*:°~o,;,,_ Sworn and ubscribed before me
This ~ ay of 2009 rE
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Signature ublic Notary -State of Flo Signature of ui
Notarization of Lobbyist's signature Notarization of
TO BE COMPLETED BY CITY CLERK'S STAFF
Annual Registration fee: [ ]Yes [ ] No Amount Paid $ MC.(2 A~
Lobbyist Registration Form received and verified by:
E;'~~ ~ ~~rLC~'~t,i7Y~~"t ~~'f~~ts~ayi~e e~isCr~~i~~z ~~ ~9, ~.t~~ie:
signature
Date Paid
Revised 02/ 11/ 2009
City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, W"~'^'.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.7411 ,Fax: 305.673.7254 CityClerk@miamibeachFl.gov
LOBBYIST NAME: l~hr;s~,D~
V y~S<i~
I understand that no later than October 1st of each near, I must file the followin
forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk'gs
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.
Signature:
~ -~ ~~
Date:
F:lCLER1LOBBYISTti_obbyist Registra#ion Form 3270&.doc