Billy L. Doolin/VCA Grant('I C-L l ~ A DIFn'C~ ~ SS.
G~'f'"
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
104 ~IU~ -3 Ali iQ~ 59
CI?''r' C~.L- ;;~°S OAF iC~
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat or mod'rfication 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
spec~cally includes the principal as well as any employee engaged in lobbying activities. The term "lobbyists" has speclflc exclusions. Please
refer to Ordinance 20043435. // /
~nn ~ h~ ~i ~ll { -C
NAME OF LOBBYIST: (Last) (First) (M.I)
lY~i y' ~~ ~GNC~ ~st ;'e~~-~i~N l//S%~ S`~`' /~ w S~P~~J /~~, ~~ 3 3130
B SINESS NAME AND ADDRESS (Number and Street) (City) ~" (State) / I (Zip Code)
S~(1..~'~~/~-~~~~ .~~J~"~Ll/'///,~ ,C~1~~1~~'_i~~Orid~C/G~tcea550rifi~ie~
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
gut this section if principal is a Corporation, Partnership or Tru
• 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:
i`
II.S ECIFI,Cf LOBBY ISSUE: 1 ~~ L
~ .tJl ~ l's° G T ~Y 0 ~/1 ~i u u r~ ~ fT ~adU ~I/C i ~ ~ ~ IrUI/V ~F'Y ~PS / ~ r(l-0 -'~4,vC
Issue to be lobbied (Describe in detail): ~.~C , ~ ~i d rti5 _ _S ~, ~ ~ ~°~~
ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-48218)
include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise 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 the
commencement of service of City personnel to be lobbied.)
A Full Name of Individual Title B) Any Financial, Familial or Professional Relationship
~( Fit ~ F ~ S l ~07,z,,~r 'r ~ ,~
5 ~ .~-'
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ~ D , )
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ~~ «'
(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 ®No• Are you lobbvinq on a present or aending bid for goods. equipment or services, or on a
aresent Or aending 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 pending application for a Develoament Agreement with the City or
-~ application for 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 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 ^ No: Are you representing snot-for-profit corporation or entity without special compensation or
r reimbursement. .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: / PRINCIPAL IDENTIFICATION:
FL Dt...N<
~roduced ID ~~ 1~L#,D~~-p7a-55-394-d ^ Produced ID ~46~" 07a ;~$-3~~{~ v
Form of Form of Identification
g ;~;~i. "'••.,, ISABEL SATCHLI.L
~' ; MY COMMISSION A Q!),8798fl1
^ Personally known (Lobbyil~;th•.:.' - EXPIRES: April i tJ~rso Ily known (Principal
5 ' •~:Y;;~h Bonded Thru Notary Public Underwriters ~ „~,",•,, ISABEL SATCFIEIl
VII. SIGNATURE AND STAM MYCOM!~ISStoNt«ooe~aeat
z ~ EXt'tRES: lu:~~il 13, 2013
State of Florida, County of Miami-Dade State of Florida, County of Mia Bn=•:iss rhruNorayPUbl'~cundeltiNftere
Sworn to and subscribed before me ~~'g Sworn and subscribed before m
This :~ day of vnJt° , 2008 9 This _„~day of vn~~ , 20Q8~q
~~-~- c~~C._.
Si ature of ublic Notary -State of Florida Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature ~
TO BE COMPLETED BY CITY ERK'S STAFF ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid $ MCR # Date Paid
Lobbyist Registration Form received and verified by: N~~F~
F:\CLER\LOBBYIST\Lobbyist Registration Form 32708.doc „~, Revised 03/ 7/2008 ~1/
P~~~/t -`
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-482,pf the Miami ~eac~h.,City Code and all reporting requirements.
~~
x >M ~ ffi
`} ~ j 'l ~ ~
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CilyClerk@miamibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: ~ ~ ,~, _/'~lJl/ ~-
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.
2~~ ~ ~ ~
~~
Signature: Date:
F:\CLERILOBBYIST\Lobbyist Registration Form 32708.doc