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Clifford A. Schulman - Van Wagner Communications, LLC CowlIA rv(CAT( _ i\A MIAM1BEAH H City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LO BYIST REGISTRATION FORM Lobbyist means all persons employed or retained, whe er paid or not, by a principal who seeks to encourage the passage, defeat or modification of any ordinance, resolution, action or decision of any co missioner; 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. , 4 Cif 1/0/ h • NAME OF LOBBYIST' (Last) (First) (M.I) We Stpo ft y e I - 1 i 4 / El .41. 02 5 9 t 5 P462 b e Leal 6A/d1, S a f e 7 0 0 (0/4/ �/ e.) FL ?313 y BUSINESS NAME AND ADDRESS (Number and Street) (City) / (Stag) (Zip Code) ( 3os-) g5' - o30 ci y — o 23oi3 Cs / /ir 1i 4 1,gC/.COM ELEPHONE NUMBER: NUMBER: EMAIL: Please notify this office if your contact information changes: address, phone, or e-mail address. I. LOBBYIST RETAINED BY: 1/4 A W 4 y e l e P 0/ 4 / r l v n 1 C a i l . a n s � , L 4 -- L NAME OF PRINCIPAL /CLIENT: 800 T1, i ilv(w we N e w / d , 1 - p r y / o oa c / BUSINESS NAME AND ADDRESS (Num ler and Street) (City) (State) (Z' Code) (a la>h99 -R4 3b . ^e f - s f e I �E re V4A W4 40). co/11 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporatio , Partnership or Trust [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNE", OR BENEFICIARY • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II, I(' Lo ... i, .,E - FT r qd V /I - ii _CerVICO � / 1 / &Qc Issue to be lobbied (Describe in detail): 111. , , , 1 4 ) 1,„„.„,.!)„. s 1 . ,) , ;:.},! , 71 , X, ; 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 .= rsonnei sought to be lobbied -- further, pursuant to City Code Section 2- 482(a)(4) include a statement of any contra tual relationship (paid or unpaid) from 12 months preceding said City personnel' commencement of service with he 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 f 4 0 d Co4vn./33; °1 I 1 t IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) 950 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required) - OW' 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 resent 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 Deve ment 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 ( ) 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 ap earance, whether direct, or indirect, to express support of or opposition to any item, all 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 LOB YIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS ELL AS COMPEN ION RECE D, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEM NT SHALL BE F]L EVE T " E HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature 0 obbyist I do solemnly swear that all of the foregoi g fa is are true - d correct and that I have read or am familiar with the provisions contained in Section 2 -482 of the Mimi Beach City ode : nd,ey re. • a ing requirements Signature of Lobbyist , i.... . Signature of Principal /Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ❑ Produced ID ❑ Produced ID Form of identification Form of Identification D'P ersonally known (Lobbyist) ❑ Personally known (Principal) VII. SIGNATURE AND STAMP OF , • ,'; z^ _ —__ -` • MONIWIE SAHFUfF•AAVELO • .•• :.t Mi'COMMISSION 4 EE032167 State of Florida, County of Miami -Dade ` , JEXPIRES: November 21, 2014 State of Florida, County of Miami -Dade Sworn + an subscribed b-fore me • BOW Thra Notary PubkUndenvi rs Sworn and subscribed before me This 6 day of _,,,,-0: • , ,'' This day of , 2011 _.....iiiiiiii10111170 —awe Sign- - - of Publ' ' "e of Florida Signature of Public Notary — State of Florida • - ri • of L. - gnature Notarization of Principal's signature / TO BE COMPLETED BY CITY CLERK'S STAFF ONLY ` Annual Registration fee: [ ° ] Yes [ ] No Amount Paid $ . , , . MCR # . .7 , Date Paid Lobbyist Registration Form received and verified by: F. CLERN$ALLaaFORMSlLOSIMSrT Lobbyist Annual ' . istration Fran €m,doc '' i - t 2.....L- 0 Revised 1./21/2011 1 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) LOAN,' B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPS SATION): �(7UP i (Required). The following information must be answered: 1) Pursuant to Miami Beach City Code Sectio 2 Entitled Prohibited Campaign Contributions By Lobbyists On Procurement Issues ": Nd' Yes ❑ No: Are you lobbvi is on a present o Pending bid for goods. equipment or services, or on a present or pending Ele award for goods. equipment ors rylce? 2) Pursuant to Miami Beach City Code 2 -490 ntitied "Prohibited Campaign Contributions By Lobbyists On Real Estate , Devel pment 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, s all 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 SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENS ION RECE 0, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FIL EVE T — r E HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature o obbyist I do solemnly swear that all of the fo - .. t • g fa, is a = true . d correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Mi- mi Beach Ci ode : nd�i re. • I ing requirements. Signature of Lobbyist: i 4641.1. 4 Signature of Principal /Client: / *K' VI, LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: i ❑ Produced ID ❑ Produce ID Form of Identification Form of Identification ersonally known (Lobbyist) Personally known (Principal) VII. SIGNATURE AND STAMP OF ,' • ,i '" mp SARRAFF- AAVELO : ,•, ....-1 MY COMM ISSION It EE032t67 {f 1 .1,2, , 7, 'sv'L, State of Florida, County of Miami -Dade ' .,.�. •z EXPIRES: November2t,2o14 • State of F , County of N s Sworn t n a subscribed ■ b-fore Ire • •if fe e•Medlin war/ Puws/ursd•swritm 3 Sworn and subscribbed efore me This b day of =r , , • or subscribed This 2' "day of ". __) `-..� 2011 �� - -- — - 7' SAN TYSOWSKI i � _� — _ i. UBLIC. State of NewYOrk Sign- - = of Pub • • •',. ; — '? of Florida Signature of ublic Notary 2TY60- 9334 9 g ry — State o lorida • • - ri - 'o of L • " • is - gnature Notarization of Principal's signatu QUalified in New fork County 11111■ COrtificate Filed in New York County TO BE COMPLETED BY CITY CLERK'S STAFF ONLY ©OnnitiiliSsion Expires August 26, 2014 e q�l9$ rr5f*i zEat3 sd =�;5! <� I Q t 7.,�?E"T s ... ..f #i� �' }�t I.g,.;„ • id k . 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