Jeff Friday' , ~~~ .
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City of Miami Beach Office of the City Clerp Q _$ P~9 4.42
1700 Convention Center Drive, Miami Beach, FL T~~
LOBBYIST REGISTRATION FORM C { I '( ~; I_ ~. r ~ ~i ~ J G ~ ~- i L
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, decsion or recommendation that foreseeably will be heard or reviewed by the city commission, or a city board or committee. The term
speaficaly indudes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please
refer to Ordinance 20043435.
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NAME OF LOBBYIST: (Last) (First) (M.I)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
_(~{!~ . 3~S . ZIP{ ~ 6k6.3~S .2oS`~ ~,.~d~°.~srs~-@-I;t,•~'~w.lt~e-c~~u
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I. LOBBYIST RETAINED BY: ~~ \~,~ ~ ~ Cow -
FILu~. l-z ~e , ~ ~c -
NAME OF PRINCIPAUCLIENT:
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is Corporatio Partnership or Trust [Section 2.482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ~ C~ `F(LC~
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST: J e ~- ~-~L~'~ ~
It.SPECIFIC LOBBY ISSUE: ~ n r-- r--
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Issue to be lobbied (Describe in detail):
--
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city CodO section 2.4ez(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)(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.)
V~~
s~
' N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ~~ F~ ~(1,c~~ ~~ ~.~ Co , CCU ~
B) PRINCIPAL'S DISCLOSURE (OF LO BYIST COMPENSATION):
(Required). ~ 1 tti(~~ ~~ nSo i C E f LO N-P ` NS ~~J ~V \~t.~ ~ W t
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 L~l No: Are you iobbvino on a aresent or aendina bid for Bloods. equipment or services, or on a
present or pending award for Bloods. eauiament or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
,R~ea~l Estate Development Issues":
^ Yes L~l No: Are you lobbvina on a pending aoolication for a Development Agreement with the City or
aaalication for chance of zoning maa designation or change to the Citv's Future Land Use
Maa?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"IobbyisY' 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, shalt not be required to pay any registration fees.
reimbursement. .
V. SIGNATURE UNDER OATH:
n-i nnr~nrn SST ~r rwi.u vi
I do solemnly swear that all of the fo
provisions contained in Section 2-482
true and corrd6t ar~d th"at 1 /have read or am familiar with the
:h City Code and aI~ reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
is Produced ID ~ ~ p2iVa~~ ~-iCp(l1s L
Form of Identification
^ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
Neu. H Ov r N6w Llo~l~,
State of.l=lorid8" County of Miami-t3ade
Swom to~ ~bscn~efore me 1 a
This ~P r l av o ~wu-~, .209&
of
/ TO BE COMPLETED BY
Annual Registration fee: [ j Yes [ ] No Amount Paid ~
Lobbyist Registration Fonn received and vertffed by:
F:\CLER\LOBBYIST\Lobbyist Registration Form 32708.doc
PRINCIPAL IDENTIFICATION:
Produced ID N -~ 06Zr JctrS (..t Gf rVs~
Form of Identification /L
O
^ Personally known (Principal) ~p QG ~~2A
We~e.N~7ooL ric,..~, ~tas~iOGi ~~ tr ~9
State ofFfc3i'i8a, County o ade ~ ~~~ ~1- ~•
Sworn and u cribed afore e i a ~./. to ~y ~ ~~s
This ~ s y f , 2095 'dam ~~.~~qs
~ ~~ ~@~~
Signatu f Publi ry -State of Florida ~® BOG Oi,F
Notarization of P ' ci al's signature ~~ ~l~
LERK'S STAFF ONLY ~~j),
MCR # ~-~ Date Paid D ~• O~j~
__ ___ \ Revised 03/27/2008 /
m MIAMIBEACH
C'~ty of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, veww.miamibeachfl.gov
CITY CLERK Office CilyClerk@miamibeachfl.gov
Tel; 305.673.7411 ,Fax: 305.673.7254
l~ r~ ~~ ~ ~
LOBB1fIST NAME: ~.J ~
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: Dat
F:\CLERILOBBYIST1Lobbyist Registration Form 32708.doc