Dennis A. Richard/Chisholm Prop
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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 "Lobbyists" has specific exclusions. Please refer
to Ordinance 2004-3435.
Richard
Dennis
A.
NAME OF L888'r1'":.....'N'It:lit: (Last) (First) (M.!)
825 Brickell Bay Drive, Suite 1748, Miami, FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-374-6688 305-374-0384 dennis@richardandrichard.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I.
l..A\N'IeA.
L"8BBWs:r RETAINED BY:
Chisholm Properties South Beach, Inc.
NAME OF PRINCIPAl/CLIENT:
1717 Collins Avenue, Miami Beach, FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City)
(State)
(Zip Code)
(305) 779-3808
TELEPHONE NUMBER:
(305) 532-3423
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal Is a Corporation, Partnership or Trust [Section 2-482 (c)]
. NAME OF CHIEF OFACER, PARTNER, OR BENEFICIARY:
Robert Balzebre, President
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC _ISSUE:
Ritz Plaza Hotel renovation, including but not limited to construction of addition
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO ~1tS:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
City Administration, City Attorney's Office, William Taylor, Architect for Attorney
. .,.,
"J' .'Jf . 'bl ' .'J
Comrruttees, 1 pernussl e
,tIfIbllNE'f
IV. DISCLDSURE DF TERMS AND AMOUNTS OF LeBB n!ft' COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
,\ 'l1OlUIIlN .
A) 1<Il1lB)'IfKDISCLOSURE: (RequIred) $450.00 p€r J:U;lUf.
B) PRINCIPAL'S DISCLOSURE (OF~,~OMPENSAllON): (Required). $450.00 per hour.
Y
A ou re no -for- ration or
mbursement. Pursuant to Ordinance No. 2004-3435.
1) Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach Citv Code Chaoter 2, Artide VII. Division S
Thereof Entitled "Camoaion Finance Refonn" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions BY Lobbvists On Procurement Issues":
ialcom
r
Yes (i)
Are YOU lobbvinG on a Dresent or oendina bid for GOods. eauiDment or services. or on a Dresent
or oendina award for Goods. eauiDment or service?
2) Pursuant to Ordinance No. 2003-3395 Amendino Miami Beach atv Code Chaoter 2, Article VII Division S
thereof Entitled "Camoaion Finance Refonn". Via The Addition Of Code Section 2-490 Entitied "Prohibited
Camoaion Contributions BY Lobbvists On Real Estate Develooment Issues":
Yes N'
Are ou lobb i n a endin a Ii 'on for a Develo en A ment with the C' or
aODlication for change of zonin~ maD desiGnation or chanae to the City's Future Land Use MaD?
V. SIGNAT\JRE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OTY CLERK A SIGNED
STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES, AS WELL ./IS COMPENSATION
RECEIVED, IN THE OTY OF MIAMI BEAOl FOR THE PRECEDING CALENDAR Yu'R. STAlEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXP RES OR COMPENSATIO DURING THE
REPORTING PERIOD.
I do solemnly swear that all of the foregoing facts are e
familiar with the provisions ined in 2-482 of t
requirements,
Signature Of~
Signature of Principal/Client:
HTORNe.V
VI. 1:.8BIWIR IDENnFICATION:
nd correct and that I have read or am
Miami Beach City Code and all reporting
PRINCIPAL IDENTIFICATION:
l' Pr uced ID
Fonn of Identification
Personally known ~
I] Produced ID
Fonn of Identification
n Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Swom and subscribed before me
This _day of , 20_
Signature of Public Notary - State of Florida
Notarization of Principal's si9nature
L
COMMlSSlQ\I NUMBER
'" DD115603
MY COMMISSION EXPIRES
MAY 8.2006
FOR CLE '5 USE ONLY
Annual Registration fee: [ ] Yes [ /] No Amount Paid . Vb MCR # ..;:2~ '7Date Paid
Lobbyist Registration Fonn received and verified by:
Revised 02/10/04 F: CLER\ALL\MARlA-M\LOBBYISl\LOBBYIST FORM 04
9/~/cy
A"T1'D(tJ,JE II
IV. DISCLOSURE OF TERMS AND AMOUNTS OF 1..eBB .1S'f COMPENSATION (DISCLOSE WHETHER HOURL Y,
~TMrr~Ornffi~ ~
A) ~~~fJJSCWSIJRE; (Required) tSO. (\0 p.-<- k.u.. ___ _ ___~._._._________
B) PRINCIPAL'S DISCLOSURE (OF ~'fI~~MPEN5AT10N): (R"'Iuired). 11 t ~C>~ ~C__~_
Ye5 No: ~4.re V!!t! reDre~e~ti!"!o 3 r!c!-fc!'~n!'cflt C!:!"D!)!"~t!cn or en!:!:',,.' ':.'::thc:..:!: 5~.eda! comocnsati::::1 or
reimbursement. Pursuant to Ordinance No. 2004-343.5.
1) Pursuant to Ordinance No. 2003-3393 Alllendjnq Miami Beach Otv Code Chaoter 2. Article VII. Division 5
Tilt::1 t::uf Elllilieu "Calllj.)dlLl.ll Filldflt:t: ~dOlllt 'vid -rile Aulii{lon QLCoue Secdon L.~<46& Entitled "Prohibited
Camnajan ContriQutinni..f!V LobbY-lsts n"LE'ill'-:Uj"!~f!jEI)J:l;ifuJJi.~~~
Y~$ N9.; ~ Ar~'yoqJQbb.yjng._Qn i'D-resent or oendinQ bid for Qoods. eouioment or servk.es. or on a Ilresent
of.oendinq award for aoods,_ eauipment ot~ig:_?
2) Pi..ii-'';i..io,',t tv .oi-,Ji"Qi~,":,;;; N.J. 2nn3-$3~5 ;;"I-cdJ;'I'-l ;-1101111 &:cidi City CUll.;: Chaul'::i- 2. Article VII Division 5
l:hereQf Fnt!t!ed ~'r:::u~paio.'1 f!f!3!1Ce Refcrm" Vb The. /\dditic~ Qf Cede. Sf'ctie\1 2A90 Entitled "Prch:bited
r~moaian L.ontrihtltions ByJnt}.l2Yjg2. On.Bgillf?@~J}evg!Q.PJI~nU.s.~:a~~;
Yes No:
Are YOU 10bbvinG on a Dendina aDDlication for a DeveloDment AGreement with the City or
application for chanae of zonina map desicmation or chanqe to the City's Future land Use .!'1ap?
v. SlGNAnJRF. UNDER OATH:
ON OCTOBER 1'" OF EACH YEAR, EACH LOBBYIST SHALL SUBMn TO THE CITY CLERK A SIGNED
S'fATfivli;NT u....OEk VAll.., u::irlNu LuD:li,':LI;"I\i cAt-cr4L.JITuRi:S, AS W.tLL AS COMPfNSATIOt-4
RECEIVED, IN THE CITY Of ~}jlAr-lI ~[:..ca fC~ THE 'n.EC(,OU~C CALENDAR VEAR. ASTA.-fEf.1ENT
SHUI BE FIIE[I FVEN TE THE'll' HAVF REEN IIIn E'l(PENrllTlJRF5 OR COMPEiIIS.i\TION DURI!\lG THE
REPORTING PERIOD.
Signature oi'-.........". A'tTo{[tJEy
[ do solemnly swear that all of the foregoing farts are tnle and (.orrert and that T have read or ~m
familiar with the pro\(isions contained in Sectioo 2-482 of the Miami Beach City Code and all reporting
requirements.
Prrr~Ne(
Signature ofL~B,jJt.
Signature of PrinCipal/Client?'
VI. ~IDENTlFICA
PRINCIPAl.IIlI;NTIH<;:A-TJQN:
_J Product::d 10
l I Produced 1D
Form of Idefltificatiofl
Form af Ider,tifh.:iitiun
Personally known ~~,~.ir
I I Personally known (Printipat)
VIT. SIGNATURE AND STAMP Of IIIOTARY;
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..;.JlQ>.<;;: VI I lV' I".";', .........ulll.f VI 1"'IUHll"lJQUC
SV\.I(\.fJ) to at~d subscrJbed before n~
This day of . 20
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I
UDIIC Notary State of f10rlda
~Kf~~If~~ignature
,)/.,i My CornmIuion D015.me
_,/I" ExpIrts~lW,2t08
Signature of tJuOIiC Notary - ~lale or flon(Ja
Notarization of LSBh., :_;. -_ signature
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I R~~~~~(l2j~o;n~"''"''' . ,n<.. .""~"".,-... ,.,...~ ''-{''''''~ '--) F" CJFR\Al~RJA~M\tOBBYISnJ.0I38YIST FORM 04
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