Andrew W. Frey - Harry "Skip" Nashr s
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ity of Miami Beach Offi e of the City. Clerk
1700 onvention Center Drive, Miami Beach, FL 33139
LOBBYIST REGIST TION FORM
Lobbyist means all pe ons employed r~retained, whether paid or not, by a pri cipal who seeks to encourage the passage, defeat or modification of
any ordinance, resolut on, aaction or d cision of any commissioner; any action, ecision, recommendation of the City Manager or any city board or
committee; or any act on, decision or recommendation of any city ;personnel d rin the time eriod of the entire decision-makin
9 P g process on such
action, decision or re ommendation t at foreseeably will be heard or reviewe by the city commission, or a city board or committee. The term
specifically includes th principal as w II has any employee engaged in lobbying ctivities. The term "Lobbyists" has specific exclusions. Please
refer to Ordinance 20 4-3435.
III ~ ~
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N ME OF LOBBYI T: I (Last) ~ first)
' ~ (M.I)
~ ~ . ~e~~~ 1s~ ~vv~. as ~ ~ ~ ~ 3~~~ e
SINE NAME N ADDR SS (Nu er S eet) (City) (St te) (Zip Code)
~.
TELEPHONE NUM Ei: I ~ FAX NUMBER: EMAIL: '
II
Please notify t is office if your contact'informaton c anges: address, phone, or a-mail address.
I. LOBBY ~ RETAINED BY:
I ~ of
~ ; i~ SOCK ~S
ME OF PRINCI 'UOI! IEN ~ i
U~~ G~
BUSI A E ~
TELEPHONE NUMB
Fill out this sectioi
• NAME OF
• IDENTIFl
SUCH CC
n,SPECIFIC
~~
Issue to be lobbied
. nl. CITY AGE
a statement of t
appearance of an
482(a)(4) include
personnel' Comm
contractual relatia
A Full Name of I
~l~r~
~ - ~ ,~
ES ` J Number and e
i
FAX NUMBER: (Op
:ipal i a Corporation, Partnership or Try
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OFFI ER, PARTNER, OR BENEFICIARY
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:RSO S HOLDING, DIRECTLY OR INDIR
TION PARTNERSHIP OR TR ~ ST:
' ~ ,
-,(State) (Zip Code) ~
~ EMAIL: (Optional)
2-482 (c11
Y, A 5% OR MORE OWNERSHIP INTEREST IN
~1/en~~Crs ~~~~~
in d tail): ~ I ~ •`
~~~
-IIV IVIQl1AL~ TO BE LO BIER: Pursuant to City Code Section 2-482(g) include
of any business, ~ financial, familial, professional or other relationship, giving rise to an -~~ •
-ty ith any City personnelisought to be lobbied -- further, pursuant to City Code Section 2-
ant of any contractual relationship paid or unpaid) from 12 months preceding said City
of service with the City lto the pr sent date, stating the general nature of the subject
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/Tit e; ~ I B) An Financial, Familial or Professional Relationship
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''. IV. DISCLOS RE OF TER SAND AMOUNTS OF LOBBYIST
RATE OR OTHER): ~
A) LOBBYIST DISCLOSURE: (R quired) ~ ~ ~'`. J
B) PRINCIPAL'S DI CLOSURE ( F LOBBYIST COMPENSATION):
(Required).
The following inf rmation
1) Pursuan to Miami
On Proc rement I:
t be answered:
:h City Code Section 2-488
,~.
2) Pursuan~to Miami Bach City Code 2-490 Entitled "
Real Est to Develop ent Issues":
TION (DISCLOSE WHETHER HOURLY, FLAT
~~
r1
"Prohibited Campaign Contributions By Lobbyists
ited Campaign Contributions By Lobbyists On
3) Pursuan to Miami each City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist' as set fort in Section 2-481 above) who only appears as a representative of snot-for-profit
corporati nor entity ithout special compensation or eimbursement for the appearance, whether direct, or
indirect, o express upport of or opposition to any tem, shall register with the clerk as required by this
section ut, shall not a required to pay any registratio fees.
11 Vne I]Q Ali.. r....w.. .~.... .....~.a:.--. _ .-_a s__ -__r_a ----- -~-- - - ... ... - - - -
V. SIGNA
PERIOD.
I do solemnly ;
provisions cont.
Signature of Lo
Signature of Pri
VI. LOBB
^ Produc
RE UNDER ATH:
sT n~ ~e u vi
~ 11~ J
Si tur of Lobbyist
~r that all f the foregoing facts are true an correct and that I have read or am familiar with the
~d in Sectio 2-482 of-the Miami Bity ode and all reporting requirements.
I
ID
TION:
INCIPAL IDENTIFICATION:
Produced ID
Form of Identification
Personally known (Principal)
' ' '
• ~~ Fo
Persona l
known
L m-of Identification
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)
~n ~ ? c VII. SIGNA RE ANDS AMP OF NOTARY:
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State of Florida, ounty of Mi
mi-Dade
w ~. a Q
~ Sworn t nd sub cri b fo
V~
~~ a me
~
N o This
da of 2010
o m
N ~ N C~
v o
o ;, Signature of Pub c otary - St a of Florida
A ~. Notarization of obb fist's si ature
d
TO BE COMPLETED BY CITY
Annual Registrati n fie:' [ Y s [ ] No Amount Paid $_~
lobbyist Registra 4n;Form rec ived and verified by:
F;1~LEP2'~$ALL~aFf~ t~S,~~.bBBY.t FOR~+IS~LobbyixE 12+egistrati~-n Forr
ate of Florida, County of Miami-Dade
corn and subscribed before me
is day of , 2010
nature of Public Notary -State of Florida
arization of Principal's signature
.K'S STAFF ONLY
~" MCR # Date Paid
Revised 05/2
~~
N. DISCL SURE OFT RMS AND AMOUNTS OF; LOBBYIS COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTH
i
A) LOBBYIST D SCI SURE: Required) 3 ~~`./ ~~/ 1 i
B) PRINCIPAL' tpISCLOSUR (OF LOBBYIST COMPENSATION):
(Required). I ~.
The following irlf i ~ ation must be answered:
1) Pursu I t to~ Miami each City Code Section 2-488 E titled "Prohibited Campaign Contributions By Lobbyists
~I1
On P cerement Is ues": '
2) Pursu ntlto~ Miami each City Code 2-490 Entitled "P ohibited Campaign Contributions By Lobbyists On
Real state Devel Ipment Issues": ~ '
t
3) Pursu nt~ to Miam Beach City Code 2-484 (h) An person (except those exempt from the definition of
"lobb ist") as set rth in Section 2-481 above): wh only appears as a representative- of snot-for-profit
corpo ~tiort .or ent' without special compensation o reimbursement for the, appearance, whether direct, or
indite ~ to expre support of or opposition to any item, shall register with the clerk as .required' by this
sectio but,I shall n t •be required to pay any registrati n fees. -
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^ Yes No Are ou R resentin a not for rofit co ration or enti without s cial c m satin 0
~imtiursem nt.. ; ,
V. SIGN TORE UNDE OATH: ~
~ TI
PE_
1 do solemnly
provisions cot
Signature of L
Signature of F
VI. LOB
1 1 ~ ~~
i . Si to of Lobbyist
that al of the foregoing facts are true a d correct and that I have read or am familiar with the
~ rn Se on 2-482 of the Miami Beach City ode and all reporting requirements.
.'i
^ Produ d ID
orm.of Identification
^ Perso ally known ( obbyist)
i
VII. SIGN TORE AND STAMP OF NOTARY:
State of Florida County of iami-Dade
.Sworn to ands t~scribed be ore me
This ay of , 2010
i
i ~
Signature of P b~ic Notary-State of Florida
Notarization o Lob„~,bvlst's ignature
fi
TO BE COMPLETED BY CIT
Annual Registry pn fee: [ ] es [ ] No' Amount Paid $_„
Lobbyist Regi tion Form eived and verified by:
F:`~rwLER'~snr.L~B ar~rS~LOris FoRAAS~iobb~ist Recpistr~tipr~ Fo
1
PRINCIPAL IDENTIFICATION: ev
~.
~ Produced ID ~ •
Form of Identification
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l~' Personall
know
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State of ~le~tida; County of Baele ~
Sworn and subscri d before me S
This~_day of , 2010
4
~ .
5ignat of Public Notary - fate. of Fferid~ ~~
Notar Lion of Principal's signature
LERK'3 STAFF ONLY.
MCR # Date Paid
~~ Revised 05/28/2010
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City of Miami B th, 1700 Co vention Center Drive, Miami Beach, lorida 33139, www.miamibeachfl.gov
CITY CLERK Office ~ ~, CityClerk@miamibeachfl.gov ,
Tel: 305.673.741.1 Fax: ~ 05.67 .7, 254
I
Ackno ledgem int of fines/suspense n from lobbying for failure to
colI mpl 'with City of Miami each lobbying Laws
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LOBBYIST NAME: V1 ~G~ ~
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I understand t at~ no lat r than October 1st of each ear, lobbyists subject to lobbyist'
registration ~r qui~eme is shall ;submit to the c ty clerk a signed statement under oa',th '
listing all lob yin~g ex enditures, as well as c mpensatioin received, for the preceding
calendar yea with regard to the specific issue n which the lobbyist has been engaged
to lobby. stateme t shall 1 be filed even f there have been no expenditures or
~~ compensatio during h;e reporting period. he statement shall list, in detail, each
expenditure, by cate ory, including food a d beverage, entertainment, research,
communicate n, media advertising, publications, travel, lodging and special events.
FAILURE T TIMEL FILE THE EXPENDIT RE AND FEE DISCLOSURE REPORT
WILL RESU T IN A INE ®F $50.00 PER DAY. ANY LOBBYIST WHO FAILS
TO FILET E REQ IRED EXPENDITURE REPORT BY DECEMBER 1, SHALL
AUTOMATI ALLY, B !SUSPENDED 'FROM LOBBYING UNTIL ALL FINES .ARE
PAID, UNL SS THE INE HAS BEEN APPS LED TO THE MIAMI-DADS COUNTY
COMMISSI NON THICS ;AND PUBLIC RUST. In the event a lobbyist fails Ito
either file the ~epi rt and'/or pay.the assessed fi es, the Clerk shall notify the Miami-Dade
County Com fission on Ethics and Public Trust.
I
IN ADDITI ~N, ON E AN ISSUE I HAV REGISTERED TO LOBBY ON HAS
BEEN RES ~ ~VED, AM REQUIRED TO IMMEDIATELY NOTIFY THE CITY
CLERK'S O FICE OF LOBBYIST WITHDRA AL IN WRITING. {
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Dare: