Loading...
Larry G. Fields - Fantasy Theatre Factory� ^ ` ' � City of Miami Beach Office of the City Clerk 1700 Convention Center [)rive. Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM Lobbyist means all persons employed or retained, whether paid or not, by principal who seeks to encourage the pooaagn, defeat or modification of any nndinonne, nomn|uUon, action or decision of any commissioner; any aotinn, dnnioinn, 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 aobon, decision or recommendation that fon*oeaob|ywill be heard or reviewed by the city � commimoion, or o city board or committee. The tnnn specifically includes the principal an well as any employee engaged in lobbying activities. The ba "Lobbyists" has |fi exclusions. Please refer to Ordinance 2004'3435 pop FJI, c L NAME OF LOBBYIST: (Last) (First) (M.1) roll LZ BUSINESS NAUf%AND ADDRESS (Number and Street) (City) (State) �Ip C e). _,5_4d .JS 3 TELEPHONE NUMBER: FAX NUMBER: EMAL: Please notify this office if your contact information changes:address,phone, or e-mail address. 1. LOBBYIST RETAINEo oT e- All BUSINESS NAME AND ADD R-ESS (Nufter and Street) (Cit (StafTnN 1(7p C de, '=L='""'`E'`"="E": FAX NUMBER:`~p`~'~'/ ^'~'^^'.~,`'~'~', 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, ii.SPECIFIC LOBBY� PARTNERSHIP OR TRUST: � ISSUE: Issue to be lobbied @)escribe in detail): Ili. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(a)(4)include the commissioner or personnel sought to be lobbied,and whether lobbyist has entered into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months pq[�edirwsuch person's commencement of service with the city to the present date,stating the eneral nature of the subject contractual relatians'hi Sec 2-482(a)(4) Full Name of Individual and Contractual Relationship(Explain) YES) NO title of person to be lobbied r— cn- Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,faftlial 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 � C:\Users\clorhatl\AppOata\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGODDH\Lobbyist Registration / FnnnrevoedS'30' 012.don IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (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": _Yes6No: 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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes25hlo: 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 Section 2-482(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. &Ies No: Are you representing a not-for-profit corporation or entity without s eEial com ensa •on or reimbursement. V. SIGNATURE UNDER OATH: ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TU.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. gnature of-L•'obbyist I do solemnly swear that all of theme foregoiin�g-fa,is are true!;ji d correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Co`e •alleporting requirements. Signature of Lobbyist: Signature of Principal/CA erif: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Zproduced ID f-L ��1 Vat S ,e�/G o J S ' Produced ID Form of Identification Form of Identification Personally 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 Sworn to and subscribed be ore me Sworn and subscribed before me This day o t&_4 1 1 This da f f' , �• ;r,eN' MICHAEL YAP Signature of Pu c Nota e's St of ( ri :* MY COMMISSION#EE 105257 gnature of Public otary tat MICHAELYAP Notarization Lobbyis si natu 7 .FF;: EXPIRES:August 5,2015 tarization of P incipa s sign •• MYCOMMISSWNtiEE105257 Bonded Tnru Notary Public Underwriters 'r.` EXPIRES:August 5,2015 `••• ��� Bonded Thru Notary Public Underwriters TO BE COMPLETED BY CITY CLERK'S STAFF ONLY 'Rf„ Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid Lobbyist Registration Form received and verified by: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc listration Form.doc Revised 04/27/2012 City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk@miamibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 I �S LOBBYIST NAME: I understand that no later than February 28 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, or I am no longer lobbying on that issue or for that principal, 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 fail file the required Statement by April 30th, 2012, shall be automatically susp b from loo§ying until all fines are paid, unless the fine has been lobbyist, who fails Is at cal us e from e i ly s p appealed to the arqiil�bade ty Commission on Ethics and Public Trust. C 71 d- Signatur ate: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Forwevised 5-30-2012.doc Feb 27 13 02: 25p HP5600 305-284-8863 P. 1 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 f i-f-I j NAME OF LOBBYIST: 117 (Last) (First) (M -11 -, eT _Sl�j �4 1 f.,A. Or. 7 J *SS NA ND ADDRESS (Number and Street) (City) (State) C de) BUSINE I_77 3<)s Ld TELEPHONE NUMBER; FAX NUMBER, EMAIL: Please notify this office if your contact information changes: address, phone, or e-mail address. I. LOBBYIST RETAINED BY: ek J NPE OF PRINCIPAUCLIENT, T- 61 1 jj C_ ) (Sta �p C�d e BUSINESS NAIE AND ADDRESS (Nu fter and Street) (Cit -3 _T FAX NUMBER:(Optional) EMAIL. (Optional) 4- TELEPHONE NUMBER: 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: 1 C o C-1 Issue to be lobbied Pescribe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: L/ -Mt 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 eneral nature of the subject contractual relations Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship (Explain) YES NO title of person to be lobbied ALI Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial, familial or professional 4 -; relationship,or other relationship giving rise to an appearance of an impropriety,with any current city comm issioner or city personnel who is V- sought to be lobbied as identified on the lobbyist registration form filed. Sec 2-482(g)Any Financial, Familial or Professional Relationship 107 TZ) L r, C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook183LGQDDII\Lobbyist Registration Formrevised 5-30-2012.doc /UO f_ f ok- pAo, 17- Feb 27 13 02: 25p HP5600 305-284-8863 p. 2 IV. DISCLOSURE OF TERMS AND AMOUNTS'O'F.LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) 81 PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (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"; ' o r services or on a resent or pending g _Yes6No: Are you lobbying on a present or pendlnq bid for goods,equipment _�— - award for goods,equipment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": —Yes, No: Are you lobbying on a pending application for a Development Agreement with the City or application for chancle of zoninq map designation or change to the City's Future Land Use Map? 3) Pursuant to Miami Beach City Code Section 2-482 (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 spdcial 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. &es No. Are you representing a not-for-profit corporation or entity without special compensation or reimbursement. - V. SIGNATURE UNDER OATH: ON FEBRUARY 28 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 FtLED EVEN IF-.THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. �-•�° i.,_.:.' '-Signature of Lobbyis swear that all of he fgce oingJatts,are true.and correct and that I have read or am familiar with the provisions contained I dosolemnly �,.,. 9 ... in Section 2-482 of the Miami Beach C..ity"Code a,yrl� all rgporting requirements. Signature of Lobbyist: � �• - �� ya Signature of Principal/flier& VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: �L � Itare's s Produced ID`�t• `� uroduced ID f' � ll✓ — Form of Identification Form of Identification "- Personally known (Principal) Personally k nown(Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade State of Florida, County of Miarni-Dade Sworn to and subscribed before me Sworn and subscribed before me This �•'� day o t' 1 This " da f r ► '"" MICHAELYAP Signature of Pu c Nota St of Seri MYCOMMISSIONEE105251 gnature of Public otary tats Mo{AELY1+P August 5 2015 `• I+SY COMMISSION II EE 105257 :a. EXPIRES:Aug t ��= rization of P inci at's sign �i Notarization Lobbyis s si natu �, �;,• 9ondcdThruNolary PubVcUndervrriters to p 9 :,:�.x ) ;= EXPIRES:Augus15,20t5 —RUN Bonded Ttvu Notary POIC UndetvKi6ers TO BE COMPLETED BY CITY CLERK'S STAFF ONLY �'�r Annual Registration fee: [ ]Yes[ )No Amount Paid$_O MCR# O - X49 - c Dace icl Lobbyist Registration Form received and verified by: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc Feb 27 13 02: 2Gp HP5G00 305-284-8863 P. 3 listration Form.doc Revised 04127/2012 City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov CITY CLERK Office Rafael E. Granado, City Clerk Cl[yClerk@n)iomil)eaclifl.gov Tel:305.673.7411 jax: 305.673.7254 1' I LOBBYIST NAME: I understand that no later than February 28 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, or I am no longer lobbying on that issue or for that principal, 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 fail file the required.Statement by April 30th, 2012, shall be automatically suspended from lo ing.0 until all fines are paid, unless the fine has been i appealed to th"eiaami,.bade c ty Commission on Ethics and Public Trust. C) Signatures'. 7 43ate: C:\Users\clerhatl\AppData\Loca]\MicrosoftlVVindowslTemporary Internet Files\Content.Outlook183LGQDDH\Lobbyist Registration Forwevised 5-30-2012.doc Feb 27 13 02: 26p HP5600 305-284-8863 p. 4 F 7 C 6 F MISSION. FTF's mission is to cultivate and develop appreciation,understanding and love of theatre,specifically III children.We support art by stimulating imaginations and setting conditions for creative thinking.As a touring company, we develop original shows,accessible to people froin all back-rounds.FTF's Project Smile,provides a free policy for critically ill children and other special needs groups. . . •7069 SW 47th Street Miami, F1 33155 305-284-8800 email: larry@ftfshow.S.COM webpage: www.ftfshows,com Attentilon Silvia Lobbyist Re gistration Form for Larry Fields. 2 Pages. includin g cover:.