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Michael J. Marrero - Joe Littlem MIAMIBEACH 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 term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. Marrero Michael J. NAME OF LOBBYIST: (Last) (First) (M.I) Bercow, Radell & Fernandez, P.A. 200 South Biscayne Blvd., suite: 850 Miami, Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 377-6238 (305) 377-6222 mmarrero@brzoninglaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Joe little NAME OF PRINCIPAL/CLIENT: CBS Outdoor Inc. 2640 NW 17"' Lane Pompano Beach Florida 33064 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 a Corporation, Partnership or Trust [Section • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Wally Kelly, President • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: CBS Corporation II. SPECIFIC LOBBY ISSUE: Amendment to Settlement Agreement Concerning Outdoor Sign Located at the South East Corner of the Intersection of Arthur Godfrey Road and Alton Road, Miami Beach, Florida Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship Ci Commission Mana er's Office Plannin Staff 5~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHERt A) LOBBYIST DISCLOSURE: (Required) $350/hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $350/hour 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": ^ Yes X No: Are you lobbvina on a aresent or pendina bid for goods, eauipment 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": ^Yes X No• Are you lobbying on a oendina application for a Develoument Agreement with the City or application for chance of zoning map designation or chance to the Citv's Future Land Use Man? 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 X No• Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. ~.~-, /.1~ Signature of Lobbyist 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 ' ~~ of the Miami Beach City Code and all reporting requirements. /'~ n Signature of Lobbyist: Signature of Principal/Client: vI. LosBYIST ^ Produced ID ` Form of Identification personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: ~' a 8 ~ State of Florida, County of Miami-Dade Sworn and subscrib efore me This ~~ y of 20 ~ 0 .. ~ Si natur Public Notary -State of Florida N tariza on of LobbvisYs~ignature PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification LYPersonally known (Print a~~-~""~e : CAROL NNwILLETT ~~°' Notary Public -State of Florida ~,9, ,= Wly Commission Expires Feb 19, 2012 '%;~~o ~~~~' Commission fi DD 760104 State of Florida, County of Sworn and subscribed before me This 7 t~ii of cTCFiLtlL! . 29/d _ Signature of Pub Notary"- State of Florida Notarization rincipal's signature FOR CLE Annual Registration fee: [ ]Yes [ ] No Amount Paid A ,.,~-- • Lobbyist Registration Form received and verified by: /l• L~~ F:\CLER\$ALL\MARIA-M\LObbyist\LOBBYIST FORM OS.doc o,`y ,e ?h ~yi iE ONLY ~ MCR #i(~'~ /~ Date Paid ~ l ~ l D Revised 12/08/04 1 I 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 Acknowledgement of fines/suspension from lobbying for failure to comply with City of Miami Beach lobbying Laws LOBBYIST NAME: ~ f G Q ~ ~ ~ ' _ l ~ Y r ~ rd I understand that no later than October 1st of each year, lobbyists subject to lobbyist registration requirements shall submit to the city clerk a signed statement under oath listing all lobbying expenditures, as well as compensation received, for the preceding calendar year with regard to the specific issue on which the lobbyist has been engaged to lobby. A statement shall be filed even if there have been no expenditures or compensation during the reporting period. The statement shall list, in detail, each expenditure by category, including food and beverage, entertainment, research, communication, media advertising, publications, travel, lodging and special events. FAILURE TO TIMELY FILE THE EXPENDITURE AND FEE DISCLOSURE REPORT WILL RESULT IN A FINE OF $50.00 PER DAY. ANY LOBBYIST WHO FAILS TO FILE THE REQUIRED EXPENDITURE REPORT BY DECEMBER 1, SHALL AUTOMATICALLY BE SUSPENDED FROM LOBBYING UNTIL ALL FINES ARE PAID, UNLESS THE FINE HAS BEEN APPEALED TO THE MIAMI-DADS COUNTY COMMISSION ON ETHICS AND PUBLIC TRUST. In the event a lobbyist fails to either file the report and/or pay the assessed fines, the Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust. IN ADDITION, ONCE AN ISSUE 1 HAVE REGISTERED TO LOBBY ON HAS BEEN RESOLVED, 1 AM REQUIRED TO IMMEDIATELY NOTIFY THE CITY CLERK'S OFFICE OF LOBBYIST WITHDRAWAL IN WRITING. 7 9 /~ Signature: Date: