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David Odishoo- Jason & Carrie Wisenfeld Q-0 ' MIAMI 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. V � V l L-:�> ©t--> ( s-(+0-6 NAME OF LOBBYIST: (Last) (First) (M.1) t-,)ft( C,> 33�, ( (�( � ��( , Imo- ��Z�3 BUSINESS NAME AN ADDRESS (Number and Street) (City) (State) (Zip Code) �7D5- 8 - q 21 t v(l'Ja I64,� HuTv`rMA- TELEPHONE NUMBE : FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: 2�5NA IN CLIENT: I A l �J a IN / J I ES 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: V v D IS-S I L�IJ • IDENTIFY ALL PERSONS HOLDIN DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ii.SPECIFIC LOBBY:ISSUE: � /�sC( (= t U 2-3 s - Issue to be lobbied(Describe in detail): III.CITY AGENCIES/INDIVIDUALS TOPE,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 ( W K"lC A 0:2 Pursuant to City Code Section 2482(g)Every registrant shall be required to state the extent of any business,financiajt;familfaLor professional relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner or citFersonngl who is sought to be lobbied as identified on the lobbyist registration form filed. `" t Sec 2-482(g)Any Financial, Familial or Professional Relationshi J C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc L r IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) FL&T 10�A--� B) PRINCIPAL'S DISCLOSURE(OF L T MP€NSATSN): B (REQUIRED). 0 ` 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 X-1vo: 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": _Yes 4o: 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 indirec, to express support of or opposition to any item,shall register with the clerk as required by this section but,shall not be re fired to pay any registration fees. Yes o: Are you representing a not-for-profit corporation or entity witho s ecial compensation or reimbursement. V. SIGNATURE UNDER OATH: ON FEBRUARY 28 OF EACH YEAR EACH LOBBYIST SHALL SUB TO THE C C A SIGNED STATEMENT UNDER OATH LISTING LOBBYING EXPENDITURES AS WELL AS CO PE ATION REalVEAF. 10 HE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STAXEMENT SHALL EIE F ED EVEN IF/rHEjKt OVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTIN PERIOD. 14 Y f Signa f ob ff I do solemnly swear that all of th fore oing f is ar tru/� correct nd th t I miliar with the provisions contained in Section 2-482 of the Miami B ch ity Co e an all r PQ ing r u n s. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: roduced ID re .Agujep' L1C sr A'0� Produced ID fL JIet�e2S L; Form of Identification „4��°a T, Form of Identification V c Z4"c •'�a,�0 Ci % \ _Personally known (Lobbyist) yQ C;m T aS _Personally known (Principal) c m g VII. SIGNATURE AND STAMP OF NOTARY: 'T -.4 �a�c � " h °� y4J � g r W -V h G2 State of Florida, County of Miami-Dade gvo�FF,c State of Florida,County of Miami-Dade y 4 F o Sworn togidd subscrib before me ��� c+j Sw subscribed before me This of O!A� 2012 Je� "��.,, 00� _ T is day of n� 2012 Signatu o Pu lic Not ry ate of Florid %°s o; Signature of Public No a —State of Florida Notarizati n of Lobbyi s sign ture L'S Notariza on of Principal's signature TO BE COMPLETED BY CITY CLERK'S TAFF O Annual Registration fee: [ .]Yes( ]No Amount Paid$ MCR# Dat Paid 1 11 Lobbyist Registration Form received and verified by: Ir C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGODDH\Lobbyist Registration Formrevised 5-30-2012.doc" F:\CLEI lilmli.n Form.doc Revised 04/27/2012 MIAMBEACM City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,v✓ww.miamibeachfl.gov CITY CLERK Office Rafael E. Granada, City Clerk Cit/Clerk @miamibeachfl.gov Tel: 305.673.741 1 , Fax: 305.673.7254 LOBBYIST NAME: ��b W' (yHG0 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 Sta ment and in addition to any other penalties which may be imposed as provided i Section 2-485.1, a fine of$50.00 a day shall be assessed for all Statement(s) filed a er the due date. The City Clerk shall notify the Miami-Dade County Commissio on Ethics and Public Trust of the failure of a lobbyist(or principal) to file the Statem t or pay the assessed fines after notification. Any lobbyist, ho fails to He r quired Statement by April 30th, 2012, shall be autom�e�d cally uspended o I ing until all fines are paid, unle s the fine has been appe to a Miami-D d o ty Commission on Ethics an Pu is Trust Xg a re: D te: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Fwrrirevised 5-30-2012.doc