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Eric S. Katz - Clear Channel Outdoor MIAMiBEA • City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 2 W E c:: 0 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. Katz, Eric S. NAME OF LOBBYIST: (Last) (First) (M.I) Communikatz, Inc. 600 NE 52 Terrace, Miami, FL 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) Phone 305-573-4455 Fax 305-573-4466 Email rkatz @communikatz.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: Clear Channel Outdoor NAME OF PRINCIPAUCLIENT: 5800 NW 77 Court Miami FL 33166 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-592-6250 305-477-4750 jasperjohnson(a�clearchannel.com 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: Jasper Johnson, Region President, South Florida Region ! IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: publicly traded company NYSE: CCO—Clear Channel Outdoor Holding, Inc. II.SPECIFIC LOBBY ISSUE: City of Miami Beach Outdoor Advertising. Issue to be lobbied(Describe in detail): F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc Ill. ;CITY AGENCIES/INDI UALS 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 general nature of the subject contractual relationship. Sec 2-482(a)(4)Full Name of Individual and title Contractual Relationship(Explain) YES NO of person to be lobbied • x Mayor and Commissioners and their Staff City Manager and City Attorney _ x Public Works and Transportation Directors and staff, City Procurement Pursuant to City Code Section 2-482(g)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 2-82(g)Any Financial,Familial or Professional Relationship None IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $24,000/year . B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). $24,000/year The fo_llowing information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues": X Yes_No: 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 X 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 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. • Yes X No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement. F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc ® 0 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 BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION-DURING THE REPORTING PERIOD. / zt.__.4 Signature of Lobbyist 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 City Code and all reporting requirements.4 Signature of Lobbyist: c_....._ Signature of Principal/Cli-.;. f VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: F/06 ��0Virs Produced ID Produced ID �g1,E" r Form of Identification T`y ;�L. Form of Identification :i t wo•(F Personally known(Lobbyist) ,a_na_.•�.._Y _.�.�.,,�,...,�, �..p�, 0 n°�. - "JOSIE GENCO _ _.`, , ,��,�PfiY A-.9i'-, ,- °�°��ri r9 \ mo' Notary Public) Sta_tecof Florida . VII. SIGNATURE AND STAMP OF NOTARY: s. -el- , =•; 112 :• My Comm.,Expires Nov 1:3 2011 6_. - �'" t `i m� =��` ���� ` Commission#EE 220955 °' A a 9G ���F OF ��P�� - ,� �, d . B ded T ro ssn: State of Florida; County of Miami-Dade s S•Sworn to an subscrib d before me -1,4 d -- Sworn and subscribed before me - This CI q 1'day of. . ,201 o This a2 day of bar,2016- 0 0 15. 491Akt) ,Signature of Public Notary—State Florida Signature of ublic Notary — S to of Florida Notarization of - Lobbyist s signature Notarization of Principal's signature e TO BE COMPLET !.: CITY CLERK'S STAFF ONLY Annual $Registration fee: [ Yes[ ]No Amount Paid a∎ MCR# L d VDT`( Date Paid /;_ Lobbyist Registration Form received and verified by: �. 1 _ F:\CLER\$ALL\aFORMS\LOdBYIST FORMS\Lobbyist Annual Regis rat.n1 Revised 01/22/2014 • F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc • • 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 \\g " LOBBYIST NAME: 6C I 1 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 fails to file the required Statement by April 30th of each year, 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. Signature: Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc • Miscell ous•Cash Receipt [� • ` r -S'�« f� �ggi�'�(r �(�i',.f.t���a"'14i adts �4 i�:? CITY OF MI BEACH k;.-:J = ..A f f� t 5.,07.4 10,390.00 No. 4, !ii I'M':.. 1c 1 t1;i ®d f • ' ,; f ' i- ❑ Cash Credit Card 0 Check# $ '_.:. ._ .00R 201.E ' . b''c 5, : ' 1<cd-z... ' -.:,.. .',-.:, : . . Received of Address O� Aid: 5 - t tfa( ;et r''' ► i F I '''.5:-- ) , For ". -/ 6 f c0s4"+' ,I,(1r/) 0&tIj(> { A du t h-.Ly1 . . . ". r 1-)(Obki i-',--.)--- (1\1006\ Vot--.:--4fel,1- ov... ) , ,.,:,,,, . , (THIS INFORMATION MUST BE COMPLETED). f_ ; Offi of_Finance.Director ,...„'.:;„,,, ,.:,5---_-::....- y __ �F Number , . , LN-- ci.-.Licit ::; Account C Pre P arer. .mot\. c Dep ,. . . _ - ' ' ' ' V-2) CITE HALL CASHIER OFFI 1700 CONVENTION CNTR DR MIAMI BEACH, FL 33139 10/29/2015 16:10:44 A - - CREDIT CARD ''.:_,:,_ MC SALE CARD# XXXX0000K;� 1322 - ' ' `:-. Chip Card: MasterCard Chip Card AID: A0000000041010 ATC: 0019 TC: 9C13B0EA29A2228B INVOICE 0 005 City of Miami Beach-Florida SEQ#: 0005 Finance Department Batch#: 001657 Approval Code: 27425P 1 City Hall Entry Method: Chip Read 1530213-1 10/29/2015 BR1 T113 Mode: Issuer Thu Oct29,2015 04;IOPM Trans#3-3 SALE AMOUNT 3 $850.00 MCRCLERK - MCR-City Clerk $850,00 * MCR#: 408074 1 ITEM(S): TOTAL: $850.00 • Credit Car PAID $850.00 • CUSTOMER COPY Have a nice day!