Jennifer L. McConney - Garden Islands, Intl, LLC / v//\/ s ;; YC yg : I 4111'
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive „'Miami Beach, FL 33139
,.; ' LORBYIS .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.
/t CC. ' JPJf'Jt PE-
NAME OF LOBBYIST: (Last) (First) (M.I)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
3bS -573 - )6/ c3o 5 -S73 3740(.0
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TELEPHONE NUMBER: FAX NUMBER: v EMAIL:
Please notify this office if your contact information changes: address, phone, or e-mail address.
I. LOBBYIST RETAINED BY:
( /slcwtci �--
NAME OF PRINCIPAL /CLINT:
Q / s-.S s. Dr alp 44 8Jd. Solt /G ea Chem m r pt. 33 /1).6
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:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
n.SPECiF1C LOBBY ISSUE;
4J cA pat' 4 !or 07,12-8 2 G s /ar Js C c bine
Issue to be lobbied (Describe in detail):
(2N+1 13et•C
III. CITY AGENCIES /INDIVIDUALS TC BE LOBBIED:
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
c NO A.(
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 filed.
Sec 2- 482(g) Any Financial, Familial or Professional Relationship
AVA
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE: (Required) GSOv
2
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): 4
(Required). 6>m:9..0 t 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 L� 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 s
Pursuant to Miami Beach City Code 2 -490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
. pe ielopment Issues
A • . c .., . + , . "fit :,-;
❑ Yes No: Are you lobbying on a pending application for a Development Agreement with the City or application for
• Y� t ,. t , , of zoning map d4signation or change to the Cit'e 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 cpmper s or reimbursement. .
. i •
V. • SttCNATURE UNDEROA4H: , r
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 RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL B FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD. -._
c,
Si Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained
in Section 2 -482 of the Miam• C' C e and al = e - ing requirements.
Signature of Lobbyist: _______2 /
• , . Signature of Prncipal /Client: • , .
i q i
Vi. LOBBYIST IDENTIFICATION: . • PRINCIPAL IDENTI
❑ Produced ID Produced ID R5-08 • 7.x'6 • 76' .- f 1e ) '' 0
Form of Ide • • • • Form o Identification
,, ,,,, ,.
� MMIISABEL SATCHEL
r''r by'OSSION # DD 879891
�, `�` '�"
Personally known (L w: ,�,;, . EXPIRES: April 13, 2013 titers ersona •
❑ Personally k -
'. tiAg avoid Thru N Public UndenN y now �' -
' ``�^ + •
{{ 1 � -
i ISASEL SATCHEL!
VII. SIGNATURE AND STAMP 0 �I I ' R
T . i , �.. ,, ,, :.: MY COMMISSION # DD 879891
" 'P"''�"' '"` .
it.- y' EXPIRES: Apri1,13, 2013
- t'�'. ' .' ;,qa�F; I eorirerfhru adtriry b$ Underwriters
State of Florida, County of Miami -Dade State of Florida, Cout tr
Sworn to and subscribed •efore me Sworn and subscribe before me
This _ 4 , day of d„( - . , 2011 T • 44 da of , 2011
dllr,......_. ANA L. C ) - Ad / 1 206.) •
Signat re of Public • ary — State of Florida Signatur of Publi otary — State of Florida
Nota ation of Lobbyist's signature Notari tion of Principal's signature '/
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY '
Annual Registration fee: [ ] Yes [ ] No Amount Paid $ 3 5O - MCR # ,, 6 Date Paid Y
Lobbyist Registration Form received and verified by: ��
F: P\$ALL \a FOR It LOBBYIST FORM \Lobbyi Annual Registration Fora oc CAF � Revise 1/11/2011
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
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LOBBYIST NAME: N)j 1 F (-419kAiry
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 addition, once an issue I have registered to lobby on has been resolved, I am required to
immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
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