Jaime Rubinson/136 Collins Ave
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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 defined in any
manner in this section, 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 "LobbyistsW has specific exclusions, Please refer
to Ordinance 2004-3435.
12--u gc A SO r-:J
NAME OF LOBBYIST: (Last)
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BUSINESS AME AND ADDR SS (Number and Street)
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MBER:
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(First)
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(M.I)
~~H- Fe- 3~\14
(aty) (State)' (Zip Code)
~~~14
. ~ I EMAIL:
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FAX
LOBBYIST RETAINED BY:
\ 3b C,()~I f\f5 ~JE I-C--
NAME OF PRINCIPAljCUENT:
I.
\.'.S0 C-O L-L.\ IS;,. ~JE M {~, f.%:: f\? tI I 0-3-3159
(aty) (State)' (Zip Code)
AME AND ADDRESS (Number and Street)
0-q-4-~~6~ D
-
-
UMBER:
FAX NUMBER: (Optional)
EMAlL: (Optional)
Fill out this section if principal Is a Corporation, Partnership or Trust [Section 2-482 (c)l
~(t-rJ ""t()~
. NAME OF CHIEF OFACER, PARTNER, OR BENEAOARY: ~c.. 1f-11 ~,....)
F(2.I\-1'i C{ ~ f1r L-"O ~
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPEOFIC LOBBY ISSUE:
)eN L{ A:-r8.D ~U- \ Sb VGS {2..G"L A-"'n ~ -t'D tJl,f, t\l C- UJT-S I
Issue to be lobbied (Describe in detail): ~~~ ~~ A-TI ~ ~ S
III. CITY AGENCIES/INDIVlDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
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IV. DISClOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER): ,4f;.
A) LOBBYIST DISCLOSURE: (Required)
1) Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Campaion Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaion Contributions Bv Lobbvists On Procurement Issues":
nt
2) Pursuant to Ordinance No. 2003-3395 Amendino Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoalgn Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaion Contributions Bv Lobbvists On Real Estate Develooment Issues":
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST 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 PRECEDIN CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITU S PENSATION DURING THE
REPORTING PERIOD.
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 Sectio -482 of the Miami Beach City Code and all reporting
requirements.
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Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
~producedlO~~ U.C-~
tz-\ ~2-L(..zon~~e~~t.2b
~ known (Lobbyist)
VII-,-- SIGNATURE AND STAMP OF NOTARY:
PRINCIPAL IDENTIFICATION:
lJ Produced 10
Form of Identification
~y known (Principal)
Sig ture of P:s:IiC Notary. -. State of Florida
tarization 0 obbyist's signature
~.Carrie s
~...; My CommiMIon 00221814
"."", ExpIre. June 11, 2007
Signature Iic Notary - State of Florida
Notariza Ion of Principal's signature
KJ\. Carrie Sommer
;....; My ComrniMion 00221814
..."", ExpIres June 11. 2007
Annual Registration fee: [~ ] No Am un
Lobbyist Registration Form received and verified by:
Revised 02/10/04
ONL~ 62 b CJ.3s:s Date Paid ~ i- () cj