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Christopher D. Colgan .m MIAMIBEACH`S F City of Miami Beach Office of the City Clerk C5/ i v FD 1700 Convention Center Drive, Miami Beach, FL 33139 20 ll j LOBBYIST REGISTRATION FORM Ca). �� 2, P " 4 Lobbyist means all persons empoyed or retained, whether paid or not, by a pnncipal who seeks to encourage the passage, defeat or modiifoa T '3 any ordnance. resolution, action or decision of any commissioner. any action, decision, recommendation of the City Manager or any city board or Li t - F1 ` 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. 0 1 il ( l% r► sl pli 10. r D NAME OF LOBBYIST: (Las (First) (M.I) FX i l usi yP S ud- �aKkel l') s1 1 anj1'�s�s /v✓( Sum t )D3; �Ca faiW;l BUSINESS NAME AND A DRESS (Number and reet) (City) (State) (Zip Code) s(9 1 , boo_ F80 8 Sol 9,4-1-30 s epic un (cO cl usi u . cor, TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes: address, phone, or e-mail address. I. LOBBYIST RETAINED BY: NAME OF PRINCIPAL/CLIENT: BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip 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:C VW ts v D- C O( lc( --. sivAk) S- w r r < • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: u.SPECIFIC LOBBY ISSUE: i / ,,,.,,f-,,) _c64 FL__. -s i V 4. Issue to be lobb (Describe in detail): III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED: Pursuant to City Code ection 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. A) Full Name of Individual /Title B) Any Financial, Familial or Professional Relationship l M 8e *M vcA ii —S IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): s A) LOBBYIST DISCLOSURE: (Required) B) PRINCIPALS DISCLOSURE (OF LOBBYIST COMPENSATION): ( 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 lobbying 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 Real Estate Development Issues ": ❑ Yes No: Are you lobbying 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 a not - 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 No: Are you representing a not - for - profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON FEBRUARY 28th OF EACH YEAR, EACH LOBBYIST S , SUB IT T• - CITY CLE• A SI. NED STATEMENT UNDER OATH, LISTING LOBBYING E . •ENDITURES • WEL AS •MPENS • TION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE P' CEDING CAL DAR YEA . A S • TEMENT :HALL BE FILED EVEN IF THERE HAVE BEEN NO EXPEND URES OR COt :•ENSATIO ■URI.•G THE RE'•RTING PERIOD. / I ....goi ...... is.,.._. :••yist 1 do solemnly swear tha : of the foreg %' g facts . - true and . - t an. at I have read or am familiar with the provisions contained Section 2 -482 .. Mi�ach a . all rep ing requirements. Signature of Lobbyi Signature of Principal/Client: . �j'M VI. LOBBYIST IDENTIFICATI• • . P• CIPAL IDENTIFICATION: ❑ Produced ID ❑ Produced ID Form of Identification Form of Identification LINDA MEYER LINDA MEYER ■ ZPersonally known (Lobbyist), ." NOTARY PUBU 1 Personally known (Principal) NOTARY PUBLIC ` ... STATE OF FLORIDA �'. `' • - STATE OF FLORIDA VII. SIGNATURE AND STAMP' :v + �+i'• -. +'� VL►..�' "s�.� • EE028810 Comm# EE028810 • of Miami Dade Expires 1/21/2015 ` Expires 1/21/2015 State of Florida, County State of Florida, County of Miami -Dade Sworn to and subscribed before me ZO t I Sworn and subscribed before me This /1 day of �1c, nVa , X1 This It day of Jck.)nQu�N , 2410 2 1 r S. re o P blic Notary - State of Florida S j re of slic Notary - State of Florida N..: . .... : of Lobbyist's signature to . - . on of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ es [ ] No Amount Pai •' L MCR # (r �f /,,2, Date Paid / .174,2?"// Lobbyist Registration Form received and verified by: .-i 4be , /- E / / F: \CLER \$ALL \aFORMS \LOBBYIST FORMS \Lobbyist Registration Form 2010.doc Revised 05/05/2010 tr MIAMI City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityClerk @miamibeachfl.gov Tel: 305.673741 1 , Fax: 305.673.7254 LOBBYIST NAME: C/1 p I understand that no later than February 28th of each year, I must file the following form, pursuant to Section 2 -485 of the Miami Beach City Code, with the City Clerk's Office for all active lobbying issues. 1) Lobbyist Expenditure and Compensation Form Failure to file these forms on a timely basis will result in my name being transmitted to the Miami -Dade County Commission on Ethics and for code violation evaluation. In add' , once • issue ave - gister -: to lobby •n has been resolved, I am required to • mediately noti the City Cler s * ice of lob• ist withdrawal in writing. Signature: Date: