Loading...
Kapila B. Chase - Design Miami (Craig Robins)_\~ MIAMI BEACH ~~ 9~ . .~ City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 ~ 6 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 teen "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. ~..~IGSe ~~O ~ ~ G ~ . NAME OF LOBBYIST: (Last) (First) ~~Sia ~r, ~~~~~ ~ v~S41 ~E ~v~d Tue. ~~~ ~~~~~ EL BUSINESS E AND ADDRESS (Number and Street) -(City) (State) i TELEPHONE NUMBER: FAX NUMBER: E AIL: ' ~313~ 1aW\• C_t3~ Imo. LOBBYIST RETAINED BY: 1 )~1C~1f1 ~ ~ GlM1 ~ ~ra~~ ~O~Ol~ls~ ~bs~a ~, t~;ava~ ~$~1 t`1~. arm ~~C' Sty 4©d ~~avu~ ~~.. 3 't~~ BUSIN SS AME AND ADDRESS (Number and Street) (City) (State) ~ " (Zp Code) ~~S -'rJ~`a'*~}`~__C9r0 c~O ~- Jfi~ -" oSCp4 GC~G~g p,GCt'G , 6Wi TELEPHONE NUMBER: FAX NUMBER: (Optional) EM : (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] • 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: II. SPECIFIC LOBBY ISSUE: ~ 1, ~~ elf Gv~~ ~a''r ` ~1 G Ifs V~'1 ~ ~-t 1i.-l ~ ~~ 6 ~) ~S1 Cl Vl C" Ci-Y-' Issue to be lobf~d escribe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship U~ S . IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHERf A) LOBBYIST DISCLOSURE: (Required) _~G1~~~C~ B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). SG~Q~~~~ 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": 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 (No:\ Are you lobbying on a vending 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 Ma°? 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 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 s~~ec.,tion but, shall not be required to pay any registration fees.. Yes (Nol Are you representing anot-for-vrofit corporation or entity without special comvensation 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 %F THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. 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 in Section 2-482 of the Miami Beach City Code and all reporting requirements. ~~ Signature of Lobbyist: U Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: Produced ID Form of Identification Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to ,nd subscribed before me This ~ day D>~3~ed`. 20~ Stgtt3t~tFe of Public Notary -State of Florida Notarization of Lobbyist's signature PRINCIPAL IDENTIFICATION: Produced ID Form of Identification Personally known (Print ~~~ ~,, ChriStitl@ A. OIIVa ;q :.. ;Commission # DD619630 ~ Expires December 4, 2010 State of Florida, County of ~ ~~~ - ~` ded Troy Fein Insurence inc. BOfr385.7019 Sworn and subscribed before me This '~ of , Signat Public Notary - fate of Florida pjp h~~. Notarization of Principal's signature ~~yw1iN~ ~~~ / FOR CLERK'S USE ONLY ~ `~ Annual Registration fee: [ / ]Yes [ ] No Amount Paid o ~ °O MCR # ~~ Date Paid ~ y- ~ a ~ ~ ~'I'`~ , Lobbyist Registration Form received and verified by: i F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc _ ' Revised 12/08/04 G~~j~ ~ yC' Yage 1 of 1 Martinez, Maria From: JaDee Guidice [jadee@designmiami.com] Sent: Thursday, September 02, 2010 10:40 AM To: Martinez, Maria Subject:. Lobbyist Registration for Design Miami Greetings Maria, Please withdraw Alexandra Cunningham's registration as a lobbyist for Design Miami and close out her registration. Due to the fact that Alexandra will be traveling on the dates we will need to make our presentation to the VCA, we will be registering Kapila Chase in her place. thank you, JaDee Guidice Sponsor Relations Manager Direct +1 786 871 4835 Mobile +1 305 785 2170 3841 NE 2nd Avenue, Suite 400 Miami, Florida 33137 USA Office +1305 572 0866 Fax +1 305 572 0864 designmiami com designmiamiblog.com Design Miami/ The Global Forum for Design 1-5/December 2010 Miami Beach, USA VIP Opening 30/November 2010 By invitation only 09/02/2010