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Robert Switkes - F.R. Aleman & Associatesfa 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 teen "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. ~> ~~''hC~7 Y1(lC ~1r~~ ~ NAME OF LOBBYIST: (Last) (First) (M.I) BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBY S RETAINED BY: ^~ E..~ ,~ `(1 ~ 'A ~ ~ `Pty ~~~5 : ~,~, NAME OF PRINCIPAL/CLIENT B INES NAME ND ADDRESS (Number and Street) (City) (State) (Zip Code) TELEPH E NUMBER: FAX NUMBER: (Optional) EMAII • Inntinnall gut this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: `~~jt`c~~p„~Cl • IDENTIFY \LL P SONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ~~ SD~CICIi^ I nnQV iec~ te. CSR ~E-tn~ l ~~tr~S ~~~"'O v~ A Full Name of Individual Title B) Any Financial, Familial or Professional Relationship ..-- - - -~'~ " J.'~- ~~ - ~ `~'r1c~`TnJC~~ ,E t~Gj~ n~,c~Z ~Jr~ (~1+i'~`i Issue to be lobbied (Describe in detail). Ill. 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 raise to an appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2- 482(a)(4j include a statement of any contractual relationship (paid or unpaid) from 72 months preceding the commencement of service of City personnel to be lobbied.) g~ .6 ~~ az ~;~r a»a i~~~e c- IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) X .t7o~ B) PRINCIPAL'S DISCLOSURE (OF~~YI T ~QM~E~TION): • (Required). ~~( ~w 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": I~ Yes ^ No: Are you lobbvinq on a Dresent or pending bid for goods, equipment or services or on 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 I;iG No• Are you lobbvinq on a pending application for a Development 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 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. ^ Yes ~No: Are you representing anot-for-profit corporation or entity without special compensation or reimbursement.. V. SIGNATURE UNDER OATH: Signature of Lobbyist: Signature of Principal/Client VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification ~ Produced ID Form of Identification I~ Personally known (Lobbyist) Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: • r e ease uaeeea e~eou ee~ee a ee~eee~eee u u noon= State of Florida, County of Miami-Dad Ezof Florida, County of Miami-Dade Sworn~Q,ar~d subscribed befor~m ~47~~ ~ and subscribe~jb~e~fore me,,,~,,~ This ot'lJ day of y 1H31~'I~is .day of ~~"=\w .~pei^e ,19(' )Y_1~ a n e!~ t~(~ ~., /1~ _ t°1011de NoteryAean+ e .~ /1.~.y_';~~ Signature of Public Notary -State of F Notarization of Lobbyist's signature Annual Registration few[, ]Yes [ ] No Amount Lobbyist Registration Form received and verified by: .'t~~ Efi : ~(3PaY~~T t3.er6~ts~ist 32~z~a~t r~t~¢~~a ~t~rsn 3~T{~~.z!< Signature of Public Notary - ~ Notarization of Principal's si LERK'S STAFF ONLY n,. :~'w r.• caneea MCR # Date Paid _~~ pp0747842 ~ 1H3R012 Florida Naary Aem.. Boa Revised 03/27/2008 I do solemnly swear that all of the foregoi act are true a correct and that I have read or am familiar with the provisions contained in Section 2-482 of i Bea ity Co and all reporting requirements. m City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, veww.miamibeachfl.gov CITY CLERK Office CityClerk@miamibeachfl.gov Tel: 305.673.7411 ,Fax: 305.673.7254 LOBBYIST NAME: '~0~~-~ L • ~'~C,~:~1t~~~ I understand that no later than October 1st of each near, 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:tC~.'..C31'9 a"f"E~.oi~iayist egis~r~~ie~t~ Ftarar~ 327Q~,c€oc