Robert Goodman - Portman Holdings Nit v
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P V f 7 A I B E'"A H
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
I
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 i
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"Lob fists"has specific excluslo . Please refer to Ordinance 2004-3435,
NAME OBBYIST: (Last) ( irst) st (
BUSINESS NAME AND ADDRESS (Number and 5 eet) (City) (State) (Zlo Code)
(30s) ® �D / D�jn +
ELEPH NUMBER: FAX ER: EMAIL: 4
Please notify this office if your contact Information changes:address,phone,or e-mail address.
I. LOBBYIST R AINED BY:
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NAME OF PR IPAU L N :
PP ELEPHGKE A E A ADDRESS Number and Street) y) (State) (Zip Code)
NUMB R: 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:
I SPECIFIC LOBBY ISSUE:
A a AE It
Issue to be Io ied(Describe In detail):
III.CiTY AGENCIESANDIVIDUALS-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 city to the present date,stating the eneral nature of the subject contractual relationship.
Sec 2482(a)(4)Full Name of individual and Contractual Relationship(Explain) YES NO
title of person to be lobbied
' oe'
Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the e4 b s,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 2482 Any Financial,Familial or Professional Relationship
PAIA1014t 51
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
I
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 '
Issue ".
_Yes_No: Are you lobbvinq on a present or pending bid for goods,equipment or services,or on apresent or pending
award for goods,equipment or service?
2) Pursu to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
De opment Issues":
_Ye rNo: 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) Pur ant to Miami Beach City Code Section 2-482(h)Any person(except those exempt from the definition of"lobbyist"as set
f in Section 2-481 above) who only appears as a representative of a not-for-profit corporation or entity without special
ompensation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any
Xltem,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 FEBRUARY 28 OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UND
OATH LISTING LOBBYING EXPENDITURES AS WELL AS COMPENSATION RECEIVED IN THE CITY OF MiAMI BE FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE 11ILED EVEN IF THERE HAVE BEEN NO EXPENOITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
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Signature of Lob ist
I do solemnly swear that all of t Cach re ng facts are rue and correct and that I ave read or am familiar with the provisions contained
in Section 2-482 of the Miami B I p i n a nt
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID _Produced ID
Form of Identifi 'on Form of Identification
Personally known(Lobby!� • = Personally known(Principal)
z.
Vil. SIGNATURE AND STAMP `tY
State of Florida,County of Miami-Dade 4iOi0� State of Florida,County of Miami-Dade
Sworn to an subscribed efo me � FS'��s)b'S'q Sworn and subscribed before me
This day of ,201 'yF This day of ,201_,
0
I-Sibnature of Pubic Notary— tate of da �' ignature of Public Notary—State of Florida
Notarization of Lobbylst's signature Notarization of Princlpal's signature
TO BE COMPLRLE D BY CITY CLERK'S STAFFONLY eeo/
Annuaf Registration fee: .[4 s Yes[ J No Amount Palif$ !' IVICR "° ... Date Paid
Lobbyist Reglstratloh-Porm:redelved and verlOdd by:.
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IVY I AM I B EAC H
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfi.gov
CITY CLERK Office
Rafael E.Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.7411 ,Fax:305.673.7254
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 im.mediateiy 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
falls 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 falls to file the required Statement by + of each year, shall be
automaticall susp nded from byin until al fine re paid,/unless the fine has been
appealed to he mi o n f n Ethics and Public Trust.
Signature: D te:
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