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Lyle B. Stern - Development Associates, LLC • i f \ tk p AL ,,o-Af - a 4E 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 NAME OF LOBBYIST (Last) (Firs) (M I) 1 Lois S l , 5 t:Cs\■■\,., . P �l i�� aM Cjn F 3 3 l -3 i BUSINESS NAME AND ADDRESS (Number a treet) (City) ' (State) (Zip Code) 3DS --S 3 a - to ■ob 3 3 5 5` , 0.0\ . o■ry■ TEL iFj� LM FAX NUMBER: AIL. Please .notify this office if your contact information changes :.address, phone, or e-mail address. I. LOBBYIST RETAINED BY 11�� T4)0 OSSo ckkQS NAME OF PRINCI A L/CLIENT �e✓��\� f`' e,t\\ mss' C - C&. u_c_ 3131 L -tcu 6\04. S ,Las \}- ecy-S ■\) 5 D BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) Ada 1 '1b o 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 COVv R_v\ or, +Le p (\r�e;�'� e ( � \ a Issue to be lobbied (Describe in detail). Ill. CITY AGENCIES/INDIVIDUALS LOBBIED: Pursuant to City Code Section 2- 482(a)(4) include the commissioner or personnel sought to be lobbiedr 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 ''(\NO-yor O- - NQ w r e r0. �� V — ✓ C Mew C 0 d•ia\r■.■ ss%c - nr\er - . < o. � S� — c�� or. zel e Z Pursuant to City Code Sec on 2- 482(g) Eve , 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 it • IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE. (Required) IQ 0 Cam. { SQ� � B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required) N u C_ pan S 0._ cry i llq 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 o: Are you Iobbyinq 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 ,;Rt 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 OCTOBER 1 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 BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. r' • Signat / uregf obbyist I do solemnly swear that all of the foregoing facts ar rue and correct and that I have read or am familiar with the provisions contained in Section 2-4 .f the Miami Beach City Code and all reporting requirements. Signature of Lobbyist -- ? Signature of Pripa CI7 lient: VI. LOBBYIST IDENTIFICATION PRINCIPAL IDEN • o • .k ❑ Produced ID = 3 . _ roduced ID • Form of Identification, 2 0 F orm of Identificatio = r N x • i i Personally known (Lobbyist) Q g s ❑ Personally known (Principal) Z . s .._Di ¢ oh o Z , N o ii• V SIGNATURE AND STAMP OF NOTAR : ¢ — �, o ul w .-- v, z 2 State of Florida, County of Miami -Dade '','.'i ul State of Florida, County of Miami -Dad < } Sworn to and subscribed before me ∎ Sworn and subscribed before me 2 La r ' This ' ' day of .:.• 2010' li `' db gz This : day of __. 4. 'P. y'201 ( � I0; hi "`Al 'O' ' i 'ii (t's '': S Signature o •Public Notary - State of Florida Signature of !' ublic Notary - State of F z• •• • Notarization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLETED BY CRY CLERK'S STAFF ONLY 1 Annuae fei : - [ . , ; .] . Ye s '[- >-]:No,..Amoi iweaid $ �a:' ^",MCR` #- a 6 % P l:R P .'Date Pa_ id . /./ / ' Lobbyist Registration Form recew,ed and venfied by . F \CLER \$ ALL, \eFORMS \LOBBYIST FORMS Lobbyist: Registration. Form:"do ` 1 .. - .. . - Revised ^05%28% . N Y City of Miami Beach, 1700 Convention Center Drive Miami Beach, Florida 33139, www miamibeachfl.gov CITY CLERK Office CityClerk @miamibeachfl goy Tel: 305 673 7411 , Fax: 305 673 7254 LOBBYIST NAME: L Stee 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. ■ //— t .— // Signat e. Date