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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
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 term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004 -3435.
Wurst James P.
NAME OF LOBBYIST (Last) (First) (M.I)
Nichols Brosch Wurst 161 Almeria Coral Gables FL 33134
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 443 - 5206 (305) 443 - 3168 jwurst @nbww.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL.
Please notify this office if your contact information changes: address, phone, or e-mail address.
I. LOBBYIST RETAINED BY:
New National LLC
NAME OF PRINCIPAL/CLIENT
1677 Collins Avenue Miami Beach, FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
786 - 999 - 6027
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 PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST
II.SPECIFIC LOBBY ISSUE:
Historic Preservation, Floodplain Managmenent, Planning & Zoning, Public Works, Bldg. Permitting Issues
Issue to be lobbied (Describe in detail): 1677 Coll1 t&s �!j
III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED: C
Pursuant to City Code Section 2- 482(a)(4) Include the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered
Into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's
commencement of service with the city to the present date, stating the general nature of the subject contractual relationship.
Sec 2 -482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES NO
title of person to be lobbied
Building, Fire, Board of Adjustment, Planning and Zoning X
Historic Preservation Bd., Floodplain Managmenet Board X
City Manager's Office, City Commission, City Attorney X
Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extent of any business, financial, familial or professional
relationship, or other relationship giving rise to an appearance of an Impropriety, with any current city commissioner or city personnel who Is
sought to be lobbied as identified on the lobbyist registration form flied.
Sec 2.482(g) Any Financial, Familial or Professional Relationship 3M .3U S.)48.11) A 1 I)
N/A
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE: (Required)
$ 275.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $ 275.00 per hour
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2 Entitled Prohibited Campaign Contributions By Lobbyists On Procurement
Issues ":
❑ Yes ® No; Are vou lobbying on a present or pending bid for goods, equipment or services. or on a preseftt 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"
fJ Yes ® No: Are vou 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 sand 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.
rJ Yes ® No: Are vou 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 COMPENSATION RECE D. IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF TH HA BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are rue an correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami c City Cod n a repo i. g requirements.
Signature of Lobbyist 0,--..„ r,
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Signature of Principal/Client T _ a i r • ' (i i ^ �V1 eF
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VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: evAt .�
jProduced ID fl-- lx- W 03• 45S.5Z -A1 ) 0 Produced ID 1
Form of Identification Form of Identification
❑ Personally known (Lobbyist) •ersonalty known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami -Da • State of Florida, County of Miami -Dade
Swom to - nd subscribed • - e ' • `y ISABEL SATCHELL
.z Sworn - I subscribed before
This day of , 2 ► _ ` 1 _ MY COMMISSION t DD 879891 This �'. a y of ,t t OF FLORIDA
1 -STATE `-. �= EXPIRES: April 13, 2013 Karen Denis
m , ! 'Rr,S. Bonded UM ` l - •
of "= �, r oNaa , ry ublic Uncle P - _ �� �,� �l _•ti5r. = Commission #DD83b849
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= • ry - S t a t e of Florida r e o ` blic N • �+= to of Fl . • • - .••' ExPireS: NOV. 11, 2012 i
Nota on of obbvist's signature Notarization of Principal's IgnatureBOND1• THEY ATLANTIC BONDING CO., INC.
TO BE COMPLETED BY CITY CLERK'S ST F ONLY 3
Annual Registration fee: [ 1 Yes [ No Amount Paid $_ ' 5 tt ---- MGR 0 " i, ■∎_ . f Date Paid 7 / 3 ( /
Lobbyist Registration Form received and verified by 1 F •
F: VCLERI$ ALLkaFORMS\ LiOBBYISTFORMS1Lobbyis -tAnnualRegistrationForm.doc ,;ht;- Revised 1/11 011