Michael T. Andrews 9P t !—;/ V i 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.
ire W s Im ihw 1
NAME OF LOB'B/YIS/T�: I ,1 (Last) ! (First)III '
BUSINESS NAME AND ADDRESS (Number and Street) (City) I Z— I 37
(State) (Zip Code)
3 �73-Z1g3 r►,a>1c�rews �� - � rl c
TELEPHONE NUMBER: FAX NUMBER:
EMAIL:
Please notify this office if your contact information changes: address, phone, or a-mail address.
1. LOBBYIST RETAINED BY:
S 7 M-P
NAME OF PRINCIPAL/CLIENT
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:
SSU.
ygJ11i Zo /I— lZ
Issue to be iobdied(Describe in detail):
Ill.C1, '':.;AGE-N:C1E.S71ND1VIDUAL'S P HE#L OBB'IED:
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 prsonnel from 12 commencement of service with the ci to the resent date,stating the eneral nature off the subject contractual�trela ionshi preceding such person's
Sec 2-482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES NO
title of person to be lobbied
Ll Yk �itij
Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,farhi ial r f
relationship, or other relationship giving rise to an appearance of an impropriety,with any current city com p Rio is
sou ht to be lobbied as identified on the lobb ist registration form filed. � l e{tor cit personnel who i l
Sec 2-482 An Financial, Familial or Professional Relationship i�'�J
t j.�1 r
IV. DISCLOSURE DF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER. HOURLY, FLAT RATE OR
OTHcR):
q _OBBYIS- DISC'S DSilRE (Required)
3, PRINCIPAL'S DISCLOSURE (OF LOBBY!$; COMPENSATION)
(Required) L�
The following inforrnation must be answered: a en
1) ion 21588 Entitled"Prohibited Campaign Contributions By Lobbyists On Procur..m,.,.t
Pursuant to Miami Beach City Code Sect
Issues":
Yes �'No: Are you ioblo in on a resent or pending bid for goods. equipment or services or on a present or pendina
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 � No: Are You lobbying on a endin a lication for a Development Agreement with the Ci or a lication for
change of zoning map designation or change to the City's Future Land Use Ma P-?
an 3) Pursuant to Miami Beach City Code 2-494 (h as Any a pep esen`a(except e those sa enot�flor-p not-for-profit the
corporation or'lobbyist"ithoutt spec�i
Section 2-481 above) who only app support of or opposition to any
compensation or reimbursement for the appearance, whether direct, or indirect, d express reg
item, shall register with the clerk as required by this section but, shall not be required to pay any registration fees.
Yes '_ No: Are ou representing a not-for- roftt Cor oration or enti without s ectal com ensation or reimbursement.
V. SIGNATURE: UNDER OATH: iAH
ON FEBRUARY 28th OF EACH XPEAR EACH OS WELL AS COMPENSIATION R CITY
E VED CLERK
N THE CITY OF MIAMIMBEACH FOR
OATH LISTING LOBBYING t
IF HERE HAVE BEEN NO EXPENDITURES O
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FIL
COMPENSATION DURING THE REPORTING PERIOD.
do solemnly swear that all of the foregoin a is ar tr a and correct and that i have read or am familiar with the Drowslons �or;ained
in Section 2-482 of the M i Beach City de all porting requirements,
Signature of Lobbyist:
Signature of Principal/Client
Vl. LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
d .Z ] Produced IDr
produced ID Form of Identification
Form of identification
( ❑ Personally ISABELSATCHEIL
Personally known (Lobbyist) :irY'?J
' MY COMMISSION#DD 879891
?•:
a., •'< EXPIRES:April 13,2013
V►l. SIGNATURE AND STAMP OF NOTARY: :± ... � Bonded ThruNotary Public Undenvnters
State of=ionda.�
State of=iorida. County of Miami-Oad ISABEISATCHELL Sworr. and subscribed or e
"0,,,
Sworn to and subscribed b fore me :. MY COMMISSION#DD 879891 T 5 ,L3 day of
This '_today of�20", y: E ThruNo:Apri113,2013
"' ' Bonded Thru Nolary Public Underwriters
FOF J•
State Fionda Signa f Public Notary- State of Florida
iNotariz of Pubfi otary- Notarizat n of PrincipaPs signature
tion of Lob_ b_ Yi=t's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Date Paid
Annual Registration fee: [ 1
Yes [ 1, No Amount Paid S —MCR#
Lobbyist Registration Form received and verified by: Revised 1/11"2011
=ORN!5\Lotsnvrr.Annua' keaisTratron onr.tioc
MIAMBEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139, www,miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.741 1 , Fax: 305.673.7254
LOBBYIST NAME:
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.
Pursuant to Section 2-485 (d), the City Clerk shall notify any lobbyist (or principal) who fails to
timely file a Statement and in addition to any other penalties which may be imposed as
provided in Section 2-485. 1 , a fine of $50.00 a day shall be assessed for all Statement(s)
filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on
Ethics and Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the
assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April. 30th, 2012, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appeal to the iami-Dade County Commission on Ethics and Public Trust.
.P4,X (A / � ---
Signature: Date:
FACLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc