Mitchell A. Bierman - Julia M. Conway ;• , CO il 1 0
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MI AMIBEACH BEACH
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.
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NAME OF LOBBYIST (Last) (First) (M.I)
Weiss Se'f4 l-1e) f nan E-M/, a5a5 Pone De 1e0,► 7 00; Corgi 64 33/3q
BUSINESS NAME AND ADDRES (Number and Street) (City) ( SCate)
(Zip Code)
� –030 (�os2 851 -23 /n I ern,4 c,'s1 - 14kbcam
TELEPHONE NUMBER: FAX N MBER: EMAIL.
Please notify this atlas If your cor to t nfo iation changes: addi ss, phone, ore -maill address.
1. LOBBYIST RETAINED BY:
t2cl wail
NAME OF PRINCIPAL/CLIENT::
Co w� Two WA l�iA g Us p 0.8ox ;30MR / 19/ FL 33138
BUSIN N E AND ADDRESS (Number and treet) (City) (State) (Zip Code) ,
'78 ) ,935 — ( -763 6, conk' /�qr yIine Iioml.coM
TELEPHONE NUMBER: F NU BER: (Optional) EMAIL. ( t ion)
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
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— Tour &5 C CPSsion
Issue to be lobbied (Describe in detail): �+ �
111. CITYAGEN � TO BE'° R � S .
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) OYES NO
title of person to be lobbied —
M A 1O) G M in i ss i o ,► e r s B - S q
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m N '
to 1
Pursuant to City Code Section 2 .482(g) Every registrant shall be required to state the extent of any business, financial, feeRriliagi pro tonal
relationship, or other relationship giving rise to an appearance of an Impropriety, with any current city commissioner oKZity pers nnief ,ho is
sought to be lobbied as identified on the lobbyist registration form filed. -r� h
Sec 2-482(g) Any Financial, Familial or Professional Relationship
None_
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE. (Required) 39D OUP
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): 1. 350 Awr
(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 B 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
f] Yes I2 No: Are you lobbying on a pending application for a Development Agreement with the City or application for
change of zoning map designation or chance 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.
f ] Yes L7No: 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. ACH 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 BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signa re of 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 Miami Beach i Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal /Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
❑ Produced ID ❑ Produced ID
Form of Identification Form of Identification
ersonally known (Lobbyist) ❑ Personally known (Principal)
Y ( Pa )
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami -Dade State of Florida, County of Miami -Dade
Swam to and subscribe• beforp me fore me
This -71 da : 'i , 20 - Swomandsubscnbedbeforeme This day of , 2011
Si nature • ' ��� `'":' S tate of F — of Public Notary —State of Florida
No - of J. b is _ signature ation of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: f 1Yes C I No -Amount Paid S - MGR* Date Paid
Lobbyist Registration Form ibefoNtld . andi verified by
F:\CLER1$ALL aFORMS'1LOBSYIST FORMSSLobbyist Annual Registration Form.doc - Revd 1/11/2011
•
•
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE: (Required) $ 35D LU^
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): 41. 350A
(Required).
The following Information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled ` Prohbited Campaign Contributions By Lobbyists On Procurement
Issues":
E
Q Yes No: Are vou lobbvtna on a present or pendin° bid for goods. equipment or services. or on a present or pending
award for aoods. equipment or service?
2) Pursuant to Miami Beath City Code 2-490 Entitled 'Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues':
p Yes tg No: Are vou Iobbinna on a pendina application for a Development Agreement with the City or application for
change of zoning map designation or chancre to the Citv'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 dived, 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.
p Ly
Yes 'No: Are you representing a notes -profit corporation or entity without special compensation or reimbursement
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th OF EACH YEAR. ((vr 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 BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
� of Lobbyist
I do solemnly swear that all of the foregoing fads are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the M lami Beach Code and all reporting requirements.
Signature of Lobbyist ' -�
Signature of Prindpal/CIlent
VL LOBBYIST IDENTIFICATI 1 / : PRINCIPAL IDENTIFICATION:
❑ Produced ID ❑ Produced ID
Form of Identification Form of Identification
er known (Lobbyist) /Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami -Dade State of Florida, County of Miami -Dade
• Swan to and subscn . = befo : me _ Swrom . _ ► ' .: .
20` , , t - ' C
This --44-11--",,0 01
d FI ICES J. R MTELLO
Signature ° ! ? State of F r , a e ea. . � i ' re o • ubliic Notary - ,:7 + ' M I Cola � M 0.
N �' _ _ .. of Principal's ' , Commission # EE 51501 Appir dbros. Mod Maly Asia
TO BE COMPLETED BY CITY CLERK'S F ONLY
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MIAMIBEACH
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
LOBBYIST NAME: M1*k)) M-
1 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.
11 (ilii
Signature: Date:
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