William R. Thomas - Philippe Garoche )10 �
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 a 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 reco mendation that foreseeably will be heard or reviewed by the city
commission, or a city board or committee. The term specifically ncludes the principal as well as any employee engaged In lobbying
activities. The term"Lobbyists"has specific exclusions. Please refer to Ordinance 2004-3435.
Thomas-William- R
NAME OF LOBBYIST: (Last) (First) (M.I)
Unlimited Permit Services Inc-5074 NW 51 Ave-Coconut Creek- Florida-33073
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zlp Code)
954-422-8166 954-422-9972 wrt615 @gmail.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact-information-changes:address,phone,or e-mail address.
L LOBBYIST RETAINED BY:
Philippe Garoche
NAME OF PRiNCIPAUCLIENT:
1100 Stillwater Drive- Miami Beach- Florida-33141
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) nn
786-300-9167 ?hq CLr0C.1n2 @ wC,✓t y CX00 -�
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
C,
Fill out this sectlon if principal is a Corporation,Partnership or Trust[Section 2-482(c)]
g-
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY:
rri
■ IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION t
PARTNERSHIP OR TRUST: f
II.SPECIVI.C.LO'BBTlSSUE
Planning Board Hearing for new boat lift at 1100 Stillwater Drive-Miami Beach- Florida-33141 that projects mm
Issue to be lobbied(Describe in delail): than 40 feet into the waterway.
Ill.CITYAGENCIES/1NDIVIDUALS'TO°BE'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 cily to the present date staling 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
Planning Board x
Pursuant to City Code Section 2-482(8)Every 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 Any Financial Familial or Professional Relationshi
None
F:ICLERI$ALL1aF0RMSIL0BBYIST FORMS1Lobbyist Registration Form.doc
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IV. DISCLOSURE OF TERMS AND AMOUNTS_OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required) Flate Rate
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $3,000.00
(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 €No: Are you lobbying on a present or pending bid for goods,equipment or services,or an 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 €No: 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.
C Yes €No: Am you representing a not-for-profit corporation or entity-without special compensation or reimbursement. .
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th 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 EVER IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
X
Slgnalure_oi:Lotihyist
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 ity Cod and all reporting requirements.
Slgriature�of_Lobbyls�. X
Signature of Principal/Clienl; X
Vl. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
€Produced 10 € Produced iD
Form of Identification Form of identificatl
€Personally known(Lo s; ;p� �••,. €Personally known(Principal) °Rrop° 2
�, JOY BOUDREAUX o
COMMISSION#FF008887 F��.�2
VII. SIGNATURE AND STA F'P O t0 4l o.o��0
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a;_ EXPIRES A April 16.2017
State of Florida,County of Miami- R6 39 0153 FioridallotaryService.com Slate of Florida,County of Miami-Dade ` "����
Sworn to nd subscribed before Sworn and subscribet�before me ;P;5°3 S
This _day of 264 ,(90 This a2 day of AGOy (3 °'s ors°. ,
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Signatur b is ary—Slate of Florida Signature of Public Notary—State of Florida
Notarlieftri of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED B CITY CLERK'S STAFF ONLY
Annual Registration fee: [ 1 Yes[ ]No Amount Paid$ MCA# Date P
Lobbyist Registration Form received and verlfied by:
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MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
CITY CLERK Office CityClerk@miamibeachn.gov
Tel:305.673.7411 ,Fax:305.673.7254
LOBBYIST NAME: William R Thomas
.I understand that no later than February 28th of each /ear, 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 f-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
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
X /3
Signature: Date:
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