Christopher Colgan Exclusive Sports Marketing~ MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means al! 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 inGudes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please
refer to Ordinance 2004-3435.^ n
10 ~ (First)
and Street)
NE NUMBER:
Code)
S.WtM
LOBBYIST RETAINED BY:
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
out this section if principal is a Corporation, Partnership or Trust
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Ch f l5'~O~her ~~~~~-Yl
t`J` c,~.~-h ec-J Lorrc~ vie
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY ISSUE:
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 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
v~
~~ ao ~~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
IA) LOBBYIST DISCLOSURE: (Required) N'
B) PRINCIPAL'S DISCLOSURE (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
O--n,,~~Procurement Issues":
^ Yes LdNo: Are you lobbvinq on a present or pending bid for aoods, equipment or services or on a
present or pending 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":
Yew ~YJ No• Are you lobbvinq on a pending application for a Develoument 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 Ld'No: Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
nu nnTnnon ,, ST ~r ~wn~_~ v.
I do solemnly swear tha of the
provisions contained ' Section 2-4
are~e and gelFrect nd that I have read or am familiar with the
ch City de d all reporting requirements.
Signature of
Signature of PrincipaUClient:
VI. LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to n subscribed before me
This f ~ day of ~'' , 2009
i n re of u is otary -State of Florida
No n byist's signature
~ ProducedlD
Form of Id ril~~~~~~~3u~~Y~ ~~~~~„nw
Personally known (Print Camn~DDOB31452
Ex~lres 1/218011 s
• Floetia NolaryAsen., Inc
W~O~O~~~~~Y~~~~~oosef ~ou~~u~~tYH~~~~~~~~N
State of Florida, County of Miami-Dade
Sworn a subscribed before ine
This I~day of S'c,..nuar~.2009
S(ggfa re of {~ubl Notary -State of Florida
N ti rincipal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ Yes [ ] No Amount P id $ MCR # ~p3 ~D~--Date Paid
Lobbyist Registration Form received and verified by: L~>1
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\LObbyist Re ration Form 21109.doc Revised 02/11/2009
Jan.28.2010 02:58 PM
PACE. 11 1
IV. DISCLOSURE OF TERMS AND AMOUNTS OF L098YIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER;
A) LOBBYIST DISCLOSURE: (Required) A ~ I •~` (t G ~ /
8) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION)'. ~
(Required). CI ~ ~c)
The following information must be answered:
t) Pursuant to Miami Beach City Code Section Z-d88 Entitled "Prohibited Campaign Contributions ey Loobyists
On Procurement Issues":
C1 Yes I~Io: Are you lobbvin4 an_a present or pending bid for stoods eauipmgnr ~r serviCQS or on a present
Q_pendinp award for poodle equipment or servlce~
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues"~
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
°lobbyist" as set foRh 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, vi
indirect, to express support of or opposition to any item, shat{ register with the clerk as required by this
section but, shall no! be required to pay any registration fees.
n Yes~No: Are you representing snot-for-profit corporation or entity without special compensation or
-etmbursement. .
v. SIGNATURE UNDER OATH:
ON OCTOBER 1sT OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK ~.StGNED
STATEMENT UNDER OATH, LISTING L08t3YING EXPENDITURES, AS WELL AS CO(t4P~N~ATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE P CALE AR- EAR. AST MENT SHALL
BE FILED EVEN IF THERE NAVE BEEN NO EXPEN RES O COM NSA~ON DURI THE REPORTING
PERIOD.
/~
I do solemnly swear that all o e foregoing
provisions Contained in Sect' n 2-482 of theAt
Signature of Lobbyist:
Signature of PrincipahClient: ~"'~'
VI. LOBBYIST IDENTIFICATION:
`~.~••7_ SipnntUro of abyi "'
: are true - and have read or
ni Bear qty Cod d po, ' y requirem ts.
-- - --~
PRINCIPAL IDEN tFICATION:
ProducedlD Produr-ed10
Form of Identification Form of Identification
personally known (Lobbyist}
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of ~n~e `20~
Signetur of PubI11~~f latary - State of Florida
Nota~ I of-L'bbbyist's signature
-rPersonally known (Principal)
State of Florida, County pf Miami-Dade
Sworn and subscribed before me
This Z -~ day of ., ~• , ZO!O
Signature Public iyo~ary -State of Florida
Not~r' I of PF ncipal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee' [ ]Yes ( ] No Amount Paid $
MCR # Oaie Paid
Lobbyist Registration Form received and verified by'
With the
Revised 02/04/2008
m MIAMIBEACH
City of Miami Beoch, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachFl.gov
CITY CLERK Office CilyClerk@miamibeachfl.gov
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME:
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 j 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 a e registered lobby on has been resolved, I am required
to immediat ly notify t City Jerk's Off' of lobbyist withdrawal in writing.
l l~~llp
Signature:
F:\CLERILOBBYIST1Lobbyist Registration Form 32708.doc