Howard Herring
m MIAMIBEACH
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 dudng 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 tens
specifically includes the principal as well as any employee engaged in bbbying activities. The term "Lobbyists" has specific exclusions. Please
refer to Ordinance 20043435. _
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I. LOBBYIST RETAINED BY:
C`.~v L~ ~i~1n
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(State) (Zip Code)
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EMAIL:
NAME OF PRINCIPAL/CLIENT: ~ j~- '~~'
1~2~ Y'~~ .,n ~ ~ ,Cln u(~ ~u~D (t m, F~ 3313 ~
BUS~E~ E AND A~DR S 3 u ber and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482
• 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:
II.SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in de il):
ill. CITY AGENCIES/INDIVIDUALS 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 morttlts 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 Individual Title B An Financial, Familial or Professional Relationshi
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A)
B) PRINCIPAL~IS OSURE (OF LOBBYIST COMPENSATION):
(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":
present or pending award for goods. equipment or service?
application for change of zoning map designation or change to the Citv's Futun: Land Use
Man?
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 speaal 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.
reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1sT OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH LISTING LOBBYING EXPENDITURES AS WELL AS COMPENSATION
RECEIVED IN THE CITY OF MIAMI BEACH FOR THE PRECEDI CALENDAR Y A STATEMENT SHALL
BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION RING THE REPORTING
PERIOD.
Lobbyist
I do solemnly swear that all of the
provisions contained in Section 2-4
Signature of Lobbyist:
Signature of Principal/Client:
~egoing facts are t and correct and that I have read or am familiar with the
of the Miami ~ea~h~City CRde and all reporting requirements.
VI. LOBBYIST IDENTIFICATION:
R
~
~ ~
~ ^ Produced ID
'S ~ m Form of Identification
~ ~
Personally known (Lobbyist)
~~
aL VII. SIGNATURE AND STAMP OF NOTARY:
~ State of Florida, County of Miami-Dade
~~,,, Swom t and ubscrib before me
~~~
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~ This day ~t, , 2009
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:
"s its
~
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ry„'/~~ Signature of ublic otary -State of Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
0 Produced ID ~~~~-~S ! ~~~ /S~
Form of Identification .J
^ Personally known (Principal)
State of Florida, County of Miami-Dade
Swom 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 ONLY
Annual Registration fee: ]Yes [ ] No Amount Paid; ~"'- MCR # Date Paid - /
Lobbyist Registration Form received and verified by:
F:\CLER\;ALL\aFORMS\LOBBYIST FORMS\LobbviSt Registration Form 21109.doC Revised 02/il/Z009
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
~~
Florida 33139, www-miamibeachfl.gov
~ ~ Mjq~ry 6ea[h, 1700 Comenfion Center Drive, Miami Beach.
CiiyClerk@miamibeachfl.gov
CffY CLERK OFFice
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME: (.,~
nrtti~r 1st of each Year, I must file the following
I understand that no later than
ursuant to Section 2-485 of the Miami Beach City Code, with the City Cler 's
Forms, p
OFFice for all active lobbying issues.
l ~ Lobbyist Expenditure Form
2) Disclosure Form
to file these forms on a timely basis will result in my name bval at on smitted to the
Failure
Miami-Dade County Commission on Ethics and for code violation e
ion once an issue I have registered to lobby on has been resoNl ~etd, I am required
In addit ,
to immediately notify the City Clerk's Office of lobbyist withdrawal in g
~a1- ~
Date:
Signat re:
F:\CLER\LOBBYISTLobbyist Registration Form 32708.doc