Danny Aaronson - Club Madonna
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City of Miami Beach Office of the City Clerk ~OEO 5~~~ ~,~ P~~ ~: ~
1700 Convention Center Drive, Miami Beach, FL 33139 $
LOBBYIST REGISTRATION FORM ~ ~ ~ ~ f~ ~ ~` ~ ~` ~~~ ~ ~ ~ ~~ ~ ~ ~1 I`~~
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.
NAME OF
a
(First)
~~
BUSINESS NAME AND ADDRESS (Number and Stree) (City) (State) (Zip Code)
1-~
TELEPHONE NUMBER: FAX NUMB R: AI
Please notify this office if your contact information changes: address, phone, ore-mail address.
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCL ENT:
SINES A E AN A D ESS (Number and Street) (City) (St te) ip Code)
,.
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (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 P RSONS HOLDING DIRE
' CTLY R INDIRECTLY, A 5% OR MORE OWNER IP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
n.SPEC'IFIC l~OBBY ISSUE:
Issue to be lobbied (Describe in detail): '
nl. CITY AGENCIES/INDIVIDUA,LS TO BE LOBE3IED; Pursuant to City Code Section 2-482(g) 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 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.
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IV. DISCLOSURE OF TERMS AND
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOB
(Required).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
~: Are you loabving on a pending application for a Development Agreement with the City ~
application for change of zoning map designation or change to the Citv'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
in erect, 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.
~: Are you repress
reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH LISTING LOBBYING EXPENDITURES AS WELL AS COMPENSATION
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PERIOD.
Signature of Lobbyist:
Signature of Principal/Client:
LOBBYIST IDENTIFICATION: ~ `PRINCIPAL IDENTIFICATION:
~roduced ID ~T'~p5e~` ~ !~j' S~f -~-U ~ Produced ID ~~3'~a',~`3c~- ""1 ~~ - O
Form of Identification Form of Identification
^ Personally known (Lobbyist)
SIGNATURE AND STAMP OF NOTARY:
of Florida, County of Miami-Dade
rn to and subscribedbefor~ me
of `~Ji' : ,..2010
Signature of Public Notary - t to of Florida
Notariz ion of Lobbyist's sj~nature
^ Personally known (Pre
;~';::~.~"';.••,; ISABEL SATCHELL
*. #- MY COMMISSION # DD 879891
".,'•, •~ EXPIRES: April 13, 2013
~~';p~~Fti~ Bonded Thru Notary Public Underwriters
State of Florida, County of
Sworn d subscrib~l b f e me "
This~da of ~ , 2 10
Signature f Public No a ate of Florida '
Notariz on of Principal's signature
TO BE COMPLETED BY CI C ERK'S STAFF ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid $ ~ MCR #
Lobbyist Registration Form received and verified by: ~
~9 ~~.?i:~~~,t.'~;~Iw~~~,t..€~~`:I~' ~~~t-~3[~?~yi~~' ~~$~t:,-~~ita~s ~r°a~;~..~t~~ ~ / t~t_
OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
,TION):
Paid ~ /I
Revised 05/28/2010
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
Reel Estate Development Issues":
1 do solemnly swear that all of the fore oing fa are true and correct and that I have read or am familiar with the
provisions contained in Section 2-482e Mi ni Beac ity ode and all reporting requirements.
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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 Lcstws
LOBBYIST NAME: 1 1C~C1ClV '~~~~Q~l
I understand that no later :than October 1st of each near, 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.
._.... _ . ~ n ~~ ~, J
Signature: Date: