Ari L. Sklar - Mark Muhlrad• r £•.,
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City Of~Miam,I~,Bea~h.Offiice of the City Cierk
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 foreseeabiy will tie heard or reviewed by the city commission, or a city board or committee. The term
specifically includes the principal as well as any employee ingaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please
refer to Ordinance 2004.3435.
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Please notify this office if your contact
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT:
. ',1 a o '~2~.itiu4~ ~,
--BHStNEF6 NAME AND ADDRESS (Number
2nd-, r; t z, d.A wa
(First)
changes: address, phone, or e-mail address.
~.,ie,o
i Street) (City) (State) (Zip Code)
NUMBER: (Optionaq E IL: (Optional)
FIII out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR{ BENEFICIARY:
I ;
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
n.SPECIFIC LOBBY .ISSUE:
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Issue to be lobbied (Descnbe in detaU): '~
ul. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Purse ~ c
ant to City ode Section 2-482(91 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 persorinel 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 R of" service with the City to the present date, stating -the general nature of the subject
~" ciintracfual'relefion.' ' ' I
.A F411~Name of Indiv
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Title i B) Any Fi
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ncial, Familial or Professional Relationship '.
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ~ S~ ~ ~~~i~c
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST
(Required). _____
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 lobbyina on a present or pendina bid for aoods equipment qr services: or on a
present or pending award for goods equipment or service
2) Pursuant to Miami Beach City Code'2=490 Entitled "Prdhibited Campaign Contributions By Lobbyists On
Real Estate Development Issues": , , ,
^ Yes .t1Q No: Are you lobbving on`a ~pending application for a' Development Agreement with the Citv'or
application for change of zoning map desi~nation-or change to the City'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 • ~lo: Are you.representina a not=for-profit corporation .or entity without special compensation or
- i. ..'reimbursement: ... : .. , ,.. , . -
"~ V. " ~ ~ '^SIGNATURE UNDER OATH: '- . _ • ,, >, ,r. ,. ~ ~, .. .•; f..
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 contain - f th iami Beach , y Code and all repbrting requirements.
.y Signature ~of Lobbyist: ~ - " "` ' ` '" ~ ~~~
Signature of PrincipallClient:
VI. LOBBYIST IDENTIFICATION:
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Form of Identification
PRINCIPAL IDENTIFICIO•TION:
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Produced ID S4(~a- (7~a - (o(o- ~i~t,-` t]
Form of Identification
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Lld';Per~opally know Personally known I) ~~~~~
` ~ •k ~ i ;~ MY CAMMISSION.k ~ 879891
1 `~ , to ublic to -~
1. ~''/ °~ No r P S to of rlorida . " - ~ ~• ' ' ~ _ ~ `':EXPIRES Apdf13, 2013
SIGNATURE A ~;Ofadtl~~RBY: v~• ~' AondedThruNotaryPublicUnde~writers
OF P,
~.-. ~ My c,ommiyswn UU975668
tate of Florida, County o '~ it't9~de "P1es oar2s~la~a ate of Florida, County of Miami-Dade
worn to and subscribed b o e me orn and subscribed be ore me
This Z day of , 2010 This day of U , 2010
Signature of P lic Notary -State of Florida Signatur of Public tary -State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: ]Yes [ ] No Amount Paid $ d / MCLR # Date Paid
Lobbyist Registration Form received and verified by: ~ ~~ ~
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form 201 .doc Revised
m MIAM,IBE
City of Miami Beneh, 1700 Convention Center
CITY CLERK Office
Tel: 305.673.7411 ,Fax: 305.673.7254
CH
Miami Beach, Florida 33139, www.miamibeochfl.gov
CityClerk@miam ibeachfl.gov
Acknowledgement of fines/suspension from lobbying for failure to
comply with City'of Miami Beach lobbying Laws
LOBBYIST NAME: L ' ~~l ~~
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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, a ~ well as compensation received, for the preceding
ca{endar-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 reportingi 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-DADE 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 NIOTIFY THE CITY
CLERK'S OFFICE OF LOBBYIST .WITHDRAWAL IN WRITING.
7. Z./v
Signature: U Date: