Loading...
Christopher D. Adams,m PJ~IAf~,I BEACH ~Q ZQ ,~ ~ ©~v Qo ~-n City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM NAME ,ti~~ Fill out this section if principal is a Corporation, Partnership or Trust [Section 2~t82 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ~~/'l" ~~j%YIG~ • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MOR/E OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: n.SPECIFIC !LOBBY a~~ ~~~ ~~i~ - to ul. _CITY aGEN~`IE~/INDNIDUALS TO BE,'L~BBIED: Pursuant to City Code Section 2~82(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 Z- 482(a)(4) include a statement of arty 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 Tide B) Any Financial, Familial or Professional Relationship /I// ~~ ~ Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat or mod cation 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 fhe city ~mmission, 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. _„ ~ _ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FEAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) f~l ~~ //~ ~~/~ ^ ,(/'~ G~~X~t, / B) PRINCIPAL'S DISCL SURE OF LOBBYIST COMPENSATION): ~`• t /`/ (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": ^ Yes ~ No: Are you lobbvinq on a present or pendinq bid for goods equipment or services or on a present or pendinq 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 lobbvinq on a pendinq application for a Development Agreement with the City or application far 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 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. reimbursement. . V. SIGNATURE UNDER OATH: I do sofemniy swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: /~'I V!. LOBBYIST IDEN/TI~FICATION/: t~Produced ID l/~~S C. +2GhSl' Form of Identification ~ ^ ~ ^ Personally known (Lobbyist) $ ~~ SIGNATURE AND STAMP OF NOTARY: ~Z~~ ~ ~ ~,; ate of Florida, County of Miami-Dade Q ~ orn to nd subscribed before me ~ ~ is day of ~, 2009 ~~~ ~.~~••'~%~~ n ture of Pu lic Nota g ry -State of Florida ~: :~: otarization of Lobbyist's s" nature ;e / TO BE COMPLETED BY Annual Registration fee: ( ]Yes [ ] No Amount Paid 5 Lobbyist Registration Form received and verified by: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyi5t Registratio PRINC L IDENTIFICArT~ION(:~ _ Produced ID ~ `1" 2`d' © ~ J 13 ~3 ~ Form of Ident~cation , ~t%C~ / ;/ i3/1! ^ Personalfy known (Principal) ~~, ,~ te~'~~¢' ti~'i4j State of Florida, County of Miami-Dade F`~v 5~ ~~'1.~~,~'' Sworn anc~~ubscribed befor me ~`~`~' ,'~.~, ~~`~ This ~ of , 2009 ~~ ti`a' , 5~° ~'o~ '~, ~ ~ Signat e f ub otary - tate of Flo _ '~'~~' Notarization of Principal's signature a ~~;. CLERK'S STAFF ONLY ~~CR # Date Paid 21I09.doc Revised 02/ii/2009 rtrc~uu. Signature of Lo yist MIAM';BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, wv,~w.miamibeachfl.gov CITY CLERK Office CityClerk@miamibeachfl.gov Tel: 305.673.741 1 ,Fax: 305.673.7254 LOBBYIST NAME: / ~~~37D~/~` 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 immediately notify the City Clerk's Office of lobbyist withdrawal in writing. Signature: ~~~ Date. F:\CLERILOBBYIST\Lobbyist Registration Form 32708.doc