Alexander P. Heckler (2)M gg {3 .tee, n
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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 2004-3435.
NAME OF LOBBYIST: (Lasq trirst~ llv~•~J
~`~ v ffs ~- ~ r~,:u~y (-LIP 2.DO ~r ~iePow~~ ~zUD. ~2 lcri, ~~ _ ~-r~ ~, F _ 333 o I
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
X1.51-( ~ ~ `~ SAD ~ 4 ~ - 527- 78S~ ~ ~ +~ EG K tr. ~(~ ~ S ~ r ice,
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
rYL;'1 ti7 ~ ~CUGT(bN Tilt .
NAME OF PRnINCIPAUCLIENT:
-TI'~~1 (?~NST12UCTc01~ . ~C ~ 1 onn nl I~) sy :ST. ~~-r- I ~ ~Y1~m~ ~'~ ~ 3 ~ Z ~
CAM
QU, lam.
out this section if principal is a Corporation, Partnership or Trust `[Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: }}~ 2 T~`p-(L OU`~~-AI i
111 ~~' ~~S/`D`'"' 1
• 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 be lobbied (Describe 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
`Z' / ~1:~--~
.~ ,.~ ~ ~//,/1-Q
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER): ' J
A) LOBBYIST DISCLOSURE: (Required) J~~ ~ ~ /~ ~ ZS~ .,.-- ~~~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATI~-~`Q
(Required). A
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":
]III, Yes ^ No• Are you lobbying on a present or pending bid for goods, eauipment or services, or on a
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 lobbvina on a pending application for a Development Agreement with the City or
application for change of zoning map designation or chance to the City'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 lo• Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement. .
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
~ ^ Produced ID
HMO ~
~,-, c" o Form of Identification
o a? ~ v
~ aiq° ~
0 0 ~ a ~
w
~ ~ Personally known (Lobbyist)
:s
~
:~ .. VII. SIGNATURE AND STAMP OF NOTARY:
~
A o X ~ State of Florida, County of Miami-Dade
~'~ ~ Sworn to and subscribed before me
~' ,,;
~ his ~_day of , 2009
; `~
~tgfiature of Public Notary -State of Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This day of , 2009
Signature of Public Notary -State of Florida
Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF N Y ~j
Annual Registration fee: [ ]Yes [ ] No Amount Paid $ MCR # Date Paid /
Lobbyist Registration Form received and verified by:
F:\CLER~SAtt•\aFdRM51LOBBYI5T FORMS\LObbyist Registration Form 21A09.doc Revised 02/11 2009
I do solemnly swear that ail of tlge~foregoing~act~are true and correct and that I have read or am familiar with the
provisions contained in Section 2 4 o the iam each City Code and all reporting requirements.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHERJ: /
A) LOBBYIST DISCLOSURE: (Required} J'~~ ~ l /, ~ Z~~ „~ ~~C~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATI~~~~
(Required).
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":
]4 Yes ^ No: Are you lobbying on a present or pending bid for goods. eguipment or services. or on a
present or pending award for goods. eguiument 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 Clty or
application for chance of zoning map designation or change to the City'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.
Signature of Lobbyist
I do solemnly swear that a oft foregoin
provisions contained in Se ion 4 ~ the
true and correct and that 1 have read or am familiar with the
;h City Code and all reporting requirerryagts.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
<LL ~ ~ ~ ~ ^ Produced ID
cw ~ ~ ° ~ Form of Identification
F~ a~q° °
i5
o O,~ o+ ~ ~ Personally known (Lobbyist)
~.7a~v
~ ~ .. VII. SIGNATURE AND STAMP OF NOTARY:
q a~„ State of Florida, County of Miami-Dade
Sworn to nd subscribed before me
'' ?vim;: his ~_day of , 2009
c ~-
z ••,.....+'
a re of ub is Notary -State of Florida
Notarization of Lobbyist's si~ature
TO BE COMPLETED BY
Annual Registration fee: ]Yes [ ] No Amount Pald ~
Lobbyist Registration Form received and verified by:
~ Produced ID
Form of Identification
Personally known (Principal)
f~,
State of Florida, County of Miami-Dade ~ x -
Swom an ubscrib ~ befoje me ,
This ay of _~E~Ji/ 2009
Signature of Public Notary -State of Florida ~
Notarization of Principal's signature
L_ ---- _ -
C RK'S STAFF ON Y ~~
-~ MCR # at .Paid
Form 211fl9.doc
^ Yes ~lo: Are you rearesenting snot-for-profit corporation or entity without special compensation or
reimbursement. .
m
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk@miamibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: ~ ~ ~~`P~~°- ~t TT"~C-KL:E=~-
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 i me 'ately notify he Clerk's Office of lobbyist withdrawal in writing.
~~
Signature: ate:
F:\CLER\LOSBYIST\L.obbyist Registration Farm 32708.doc