Rosario A. Kennedy - Chet Atkins.,~, ~ ~ ~ I ~;~ C ~ ESC ~~~~~
_ ~, "
City of Miami Beach Office of the City Clerk
170Q 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 inGudes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please
refer to Ordinance 2004.3435. ~-~
NAME AND ,
,(t -o ?.o
(City)
ZML
3
~.~• ~
Please notify this office if your contact information changes: address, phone, or a-mail address.
LOBBYIST RETAINED BY:
Fill out this section if principal is a Corporation, Partnership or Tnust//[Section 2-482 (c}]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: G.J'~/ ~,~'ilV.s
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR IN~~IJR~ECTLY A 5°o Q ORE WNER P INT R TIN
SAIL OORA N,~Ft3'NERSHIPORTRUST: c~f~cT /~',~w.~.~; J ~~tiJ~'~
n.SPECIFIC LOBBY ISSUE:
Issue to be lobbied (Describe in detaill:
Ili. CITY AGENCIES/INDIVIDUALS TO BE .LOBBIED: Pursuant to City Code Section Z-482(8) 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 zany 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) Any Financial, Familial or Professional Relationship
CiT ~/YI
~OK~
//
.}.. ~•.1
~j,Jj
V i ~1'~~N ~: t'~.J I~o~oV
sP
IV. DISCLOSURE OF TERMS ANC AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FL^^,T
RATE OR. OTHER):
a
`1
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^ Yes ~No: Are you lobbvinq 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
Reat Estate Development Issues":
^ Yes L7 No: Are you lobbvinq on a pending application for a Development Agreement with the City or
application for change of zoning map designation 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 U IVa: Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement. .
V. 51CaNATURE UNDER OATFt:
Signature of Lobbyi
Signature of Principal/Client:
LOBBYIST IDENTIFICATION:
is N ~POduced ID i~53b'7?~'y 5-` ~~5-O
_ $ ~ ~ Form of Identification
<~¢a
y
`'1` V'w~
¢ e ^ Personally known (Lobbyist)
w
Il. SIGNATURE AND STAMP OF NOTARY:
tate of Florida, County of Miami-Dade
worn to and subscribed before me
hi~c{ay Of ~ X10
Sign~ture of PutilicitQ~otary -State of Florida
Nota ization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
~~~ ~ yY
^ Produced ID n.~U 72~ ~3 7/5 ~~
Form of Identification
^ Personally known (Pri ,~ ~gELSATCHEtl
_='~~ ~ MY COMMISSION ~ DD 879891
'`~ EXPIRES: April 13, 2013
~~ RF; k~~ Bonded Thru Notary Public Underwmers
State of Florida, County of
Sworn and subscribed before me
This L~day of ~/ , 2010
LJ
Signatu of Public tart' -State of Florida
Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ Yes [ ] No Amount Paid $ MCR # Date Paid ~
Lobbyist Registration Form received and verified by: s~ 1 i,
F:~CLERMALL\aFORhtS~LOBBYIST FORMS~Lobbyist Regestration Form 2010.doc vtseQ Q5~040 ,
The following information must be answered:
pdo solemnly swear that al foregoin~facts are tAe and correct and that I have read or am familiar with the
revisions contained in ction 2 82 of the iami Beach City Code and all reporting requirements.
City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk@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: •~~'~'O /~Gr1
I understand that no later than October 1st of a ch 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 I 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-/O
Signat e: Date: