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Frank Wolland - John De Kanelm ;.iifvv~~aE,~cy City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 '~ LOBBYIST REGISTRATION FORM p~,., gal Lobbyist means alt 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. (~10 l IGu~~ ~fc~n NAME OF LOBBYIST: o~;~ a~-Yfu~ICGJaf(~ 12-~toS~~~D;x KG~~ /idr~ir~f ~; , ~L 33 ICQ TELEPHONE NUMBER: ~-1"t u~ ~C ~ dt G ~ ~ try' - 1 Please notify this office if your contact information changes: address, phone, ore-mail address. I. LOBBYIST RETAINED BY: NAME OF PRINCIPAUCLIENT: .~ .. . ~. <. , i-,7 BUS NE55 NAME AND ADDRESS (Number and Street) (City) (State) (Zip CocTe) ~ s - ~~92- yS! o TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) a 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: u.$PECIFIC LOBBY.ISSUE: ~ ~- Q~ ~,IT, ~~~u~~~ If3 0 l C®e/~~ J. Av`ej M-eve.' I,I.¢kC~t~ ~'t-- Is§Ue to be lobbied (Describe in detail): ~./ ul. GTY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(8) Include a statement of the extent of any business, financial, familial, professional or other relationship, gluing 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 personnel' 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 An Financial, Familial or Professional Relationship `?~I~~CI ~~"ll~l:~ rlll3 I ~ .6 ~~~ 9- ~n~ aft~Z . ll (Number and Street) 3aS- ~1Z - IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) 4 U ~Ou~L2/ , aSo PRINCIPAL'S DISCLOSURE (OF LOBBYIST 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 ~ No: Are you lobbvina on a present 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 ~E No: Are ou lobb in on a endin a lication for a Develo ment A reement with the Ci or application for change of zoning mag 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 "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. ^^ Y~ ~No: Are you representing anot-for-profit cornoration or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: A\~ AI~TA~C~ AST /~c ~- w A~ ~ v~ PERIOD. ~" ~ re of ass ~ ro ~Y Ol O ~•.T' °9 _ .' me Oq ~~ ~m~~ ~~o m ~ W m~cn~ ~~a~ Z ao o~~~ c ~ oo °o ~ ~o~m ~~~~ I do solemnly swear that all of the provisions contained in Section 2-4 Signature of Lobbyist: , Signature of Principal/C VI. VII. LOBBYIST IDENTIFICA PRINCIPAL IDENTIFICATION: 'V -~`a s~v ~.~~ (~' Produced ID l~ ~ ~ ~-Produced ID Form of Identification ^ Personally known (Lobbyist) SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Swom to r~J subscribe befor me This day of , 2010 Signature of Public t9otary - Notarization of Lobbyist's Annual Reglstration fee: [" ]Yes [ ] No Amount Pald $ MCR # Date Pald V Lobbyist Reglstration Form received and verified by: { F:~CLER~$AtL\aFpRMS~LOBaYI5T FORMS~Eobktyist Registratipn Form dac Revised 05/28/2010 r-~L Form of Identification ^ Personally known (Principal) State of Florida, County of Miami-Dade Swom and subscribe~j befor me This wday of /`"~ p!~ , 2010 C~~-v. (/"V__ ?°SPR ~ P.°B~~ BARBARA J. BRUMMETT . * COMMISSION p DD 694849 Signature of Public otary -State of Q EXPIRES: August 8, 2011 Notarization of Principal's signature'F~Fr~O~~~ BondedThruBudgetNotaryServlces Y 3 facts are true andcorrect and that I have read or am familiar with the Miami Etch City Code all reporting requirements. ~_ _ a. t yk City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Tel: 305.673.7411 ,Fax: 305.673.7254 CityClerk@miamibeachfl.gov Acknowledgement of fines/suspension from lobbying for failure to comply with City of Miami Beach .lobbying Laws LOBBYIST NAME: ~-~ ~ ~iJd ~`Gi. 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, I AM REQUIRED TO IMMEDIATELY NOTIFY THE CITY CLERK'S OFFICE OF LOBBYIST WITHDRAWAL IN WRITING. - ~ ~ ~~ Signat Date: 3 ~j