Collins Ave - Principal
SENT B~ BERCOW & RADELL, PAj
~. ,. ~
3053778222;
JUL-31-02 2:30PMj
PAGE 3
. Rr:ttf,~l'r.~.
f!;3 ~ ';.>21 g ~~./1J/
CiTY CLEi\K',~.: D::?T.
City Of MiaIft Bach ClITke r1I the Cly Cetll
17ll1l Camentioft c:.nt.oIr erNe, Miami Buch, R. 3::1139
Em.i: citvcllltlllld.milrri-belch./l.u1
LOBBYIST. REGISTRATION FORM
'I . ,~, 2 .'0"'"
,'::~~~~" -- lm~.l
~~.c ~ h""~
Tim~
~..
. .
. .' ':." :
.-
.~
..._J
(CIty '" MiluTi Bach, Cty Cad. ell.pter 2, Division 3, s.etio:r1 ~.481)
II Check BoX If an ~.ndmellt
winston Jack
IIiN'lE Of LOeBVlST: (Ui.) (firs) ,
200 S. Biscayne Boulevard, Suite
BUSINESS AOCRf5S: (Nurrb:r "ld su....t) (City)
(305) 441 0727 (305) 443-6814
TELEI'HClfjE NUMBER: FA:/. NUMBER; .
(1'1.1)
1900 Miami
(Stile)
1)jl,Tl: QUAUFlED /IS I.D88VIST
Florida 33131
(ZIp Code)
DlAIl.:
1. . LOBBY'1ST RETAlNI!!D BY:
Collins.Avenue Assoicates', L.L.C.
foI.llMe OF PRINOl'AlJaJ&N'T:
100 SE 2nd street
Miami
Florida
(~t.lb!)
33131
~ Cadc)
BUSINESS ADDIWiS: . (NlIIrioer .no! StrllEt) . (~) .
(305) 995~S330 (305) 995-5340
l1!L.EPHCNE NU/'IlIER: FIJ:t.I'IUI"IBER: (Qptlanll)
!MAIL: (0pdanI1)
FIll ...~!;hill -.eII.a II prlllc:lpIIIl .." c:.rponotiOIt. ~"nn.~Ip.r Tnat [Soodiea 1.482 (c:)]
7 NAME oF Oila:' CfR(J;R, PJUml~ OR lleNEFlC,t\RY:
Don peebles
UST' ALl peJlSQt6 HCll.OlIIIG, DlRECl\.'l' ORoot~CT\.'l', A 5.. OR MCI~~6lS1ilP D('IBl5TIH S~
COIll'OAAnON. PAA'TNE1lSt<<l' OR 11UJsr: .
11.. SPECJI'IC LOBBY 1S5U~:
Board mo~ification.a lieation
nI. crTY AGEI'lClfS/1MOMDUALS TO liE LOBBIED:
A) Filii N._ or 1ncI"ldll.I/~. '. II) .......Ii....,I'
,Jorge Gomez, Director None
Tom totooney t'lone
Armando Valdes t'lone
William Carey t'lone
Se~ By:-eercow & Radell;
305 377 6226;
Jul-2Q-02 10:12AMj
Page 5/5
IV. DL'>ClO$IJRE OF 7l:RM5 AND AMOUNTS OF LOBBYlSf' l:OMPENSATION (DlSClOSf: WilmER HOlJRL Y.
FLATRATEOR. ornER):. '
^J LOBBYIST DISCLOSURE;
Hourly ($400.00)
B) PRiNCIPAL'S DISCLOSURE (OF LOIlBYlST COMPENSATION):
Hourly
($400.00)
V. SIGNATURE UNDER oAnt,
0'" ocrOBER 1ST OF EACH YEAR. EACH lOBBYlSl" SHALL SUBMITTOTHEClTY C1.ERKA SIGNED
Sl"ATEMENT UNDER OATH, ltSTING LOBBYING EXPENDITURES IN TH!; CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR.
VL
~ ProducedID _ ;]V523-l(2(-3i-tfli.! (~~M (~,\
Form of Identification ;)
I do solemnly swear that all of [ re
familiar with the provisions co . ed'
reporting requirements.
-r. Personally Known
VlL SIGNA1\lRE AND STAMP OF NOTAKi OR DepUTY ClERK,
Print, stamp or type name of Nota'Y Public
.FOR CLERK'S USE ONLY
R.egiStI1ltion: [] ACCEPrEO [] 1l.8ECT'ED DAT!::
If rejected, slllll! reason:
RegiStrilIion fee paid: [ J Yes [ ) No
[ 1 cash [ ) Cleek MeR #
DATA ENTRY DATE:
1
,2002
ENiEReD BY:
... .....\ -....-.....--.---
-----........ ......----
I !'Irs! Revision _ 05/17/02
S~T B~ BERCOW & RADELL, PAj
3053778222;
JUL-31-02 2:30PMj
PAGE SIB
IV. DISCl.ClSU~ OF 1'ERMS AND AHOUNl5 OF L08B'I'1ST COMPEN5AnON (DISa.OSI! WH~ HOURI. To
FIATRATEOR OTHtR):
A) ~OI3BY1ST DISC.CSURE:
Hourly
(5400.00)
Hourly
($400.00)
Bl PlUNCIPAI. 'S DlsaosURE (01' ~08BTlST COMPE~TION):
Y. SIGNATUR! UNDeR OAnt:
ON OCTOBER 1 Sf Of EACH YeAR,. ~CH LOBBYIST SHALL SUBMrT TO THE CITY CLERK A SIGNED
STATEMENT UNDER. OATH, USTING LOBBYING EXPENDITURfS IN l1iE aT\' Of MIAMI BEACH fOR
THE PRECEDING CALEND"R YEAR.
I do solemnly swear that all of the foregoing facts are true and corrP.r.t i1nd that I have read or am
familiar with the provisions contained in Section 2-'\82 of the Miami Beach City Code as amended, and all
reporting tel:luiremems.
Signature of Lobbltlst:
-~~~~~~~
YL LOBBYIST IDENTIflCATI ,
.e produced 10
Form of Identification
~ Personally Known
\l'n. SlGHATURf AND STAHP OF NOTARY OR bfPl1JY Cl..ERK:
State of Florida, County of Miami.Dade
Sworn to and subscribed before me
This day of . 2002.
ublic Notary - State of Florida
L JUDITH BASICEU.
Print, stam_UbliC
c.n. No. CC904814
. fOR CLERK'S USE ONLY
Reg!5tradcn: JXl ACC:EPTEO [] WCCTED
If reje::ted. sI:illle reilson:
RegI:;trallcn fee paid: PO Yes [ ] No ^
( 1 Ca:;hj,~ "'"" "'" . .~5~'5:1~
DATA eNTRV DATE: g / , );;;>--- . 2002 ENTERED B'f: ,J<).
1 /' __
DATE;
g-i-O'L
I First R.eYlslan _ 05/17/02