Karen Couty/VCA Grantm MIAMIBEACH
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City of Miami Beach Office of the City Clerk ~ ~ ?~ ;~ ~' (+,,~
1700 Convention Center Drive, Miami Beach, FL 33
TRATION FORM ~~ ~~~~' ~ Pt~ 2'
LOBBYIST REGIS 54
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the~¢~~s~~.9efe~t~gr-yu~odi~fti~odn~
any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the Ci Mana er or ~i 'di f F
committee; or any action, decision or recommendation of any city personnel during the time period of the entire decision-making process on su
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.
TELE
~~U ~-~
LOBBYIST: (Last)
~ fit) 4 ~ ~C~`~
> NAME AND ADDRESS (Number
I. LOBBYIST RETAINED BY:
~'o ~~0 ~.
NAME OF PRINCIPAUCLIENT:
IUl i a ~ i ~t SPa -tii,c
BUSINESS NAME AND_ DRESS
TELEPHONE NUMBER:
NUMBER: (Optional)
(First)
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(State)
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EMAIL:
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- ~( is yl,~,c` -~ t-- 3 3 T ~7
(State) (Zip Code)
out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• 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:
n.SPECIFIC LOBBY ISSUE:
Issue to be lobbied (Describe in de aiq: ~ ~ A ~ Q ,M~ ~„`~~ ~ ~ ~~ ~S ~ ~_jp ~
ul. CITY AGENCIESfINDIVIDUALS TQ BE ,LOBBIED: Pursuant to City Codety 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) Any Financial, Familial or Professional Relationship
(VL ~G ~M ~~ ~ ~'~~ -~4~'S ~ ~ ~
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FAX NUMBER:
~~ ~ M t ~intit ~-~i-s ~
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(Number an~Street).„ _ ~Ci
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ~ b C~,~ b~J~S~ 1 ^ ~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): O ~~~~ S~N
(Required).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 288 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^ Yes 'I!J NO: Are you lobbvina on a present or pendina bid for aoods, eauipment or services, or on a
present or pendina award for aoods, equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
_^ Yes lld No: Are you lobbvina on a pendina application for a Development Agreement with the City or
application for chanae of zoning map designation or chanae 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.
IAII Yes ^ No: Are you representing snot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist: ,~~~.~r1 , '`
Signature of Principal/Client: ~1~~~~"` L ~ ` ~'
VI. LOBBYIST IDENTIFICATION:
Produced I
""""~ CARL ANDERSSON
^ Person o roi~gion ~ DD 670426
L~Nimission Expires
May O6 20 1
VII. SIGNA
Sta a of Florida, Coun f Miami-Dade
Tw rn t~and sub~r' ore me
~'~ 2009
on
-State of Florida
PRINCIPAL IDENTIFICATION:
0 Produced ID
"~' CARL ANDERSSON
Cgmmiaaion #e DD 670426
.Personally k p y Commission Expires
May 06, ~p> >
/~
of FI rids, C Miami-Dade
~ an subscri fDfE me
This
of PUbI~Notary -
signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ • ]:Yes [ ] No Amount Paid $ MCR #
Lobbyist Registration Form received and verified by:
F:\CLEftMALI\aFDRM5\LOBBYIST FORMS~Lobbyist Registration Form 21109.doc rj Revised 02/11/2009
~p,~.
No~ `
I do solemnly 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 2-48~ of the Miami~,ea¢h City Code and all reporting requirements.
City of Miami Beath, 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:
l
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.
Sig u ' ~ Date:
F:tCLER1LOE3i3YIST1t_obbyist Registration Farm 32T08.doc