Randall Hilliard / CWA
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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
Oty 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 tenn "Lobbyists" has spedfic exclusions. Please refer to Ordinance 2004-3435.
Hilliard, Randall
NAME OF LOBBYIST: (Last) (First) (M.!)
7601 East Treasure Drive, Penthouse 221, !'brth Bay Village FL 33141
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 673-5353 Fax (305) 673-5352 rhilliard@aol.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I, LOBBYIST RETAINED BY:
Cbnmunications Workers of AIrerica IDeal 3178
NAME OF PRlNCIPAl./CUENT:
7455 Collins Avenue, Suite 212, Miami Beach FL 33141
BUSINESS NAME AND ADDRESS (Number and Street) (City)
(786) 457-7746
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
(State) (Zip Code)
noc:kinnon@cwa3178.org
EMAIL: (Optional)
Fill out this section if prindpal 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 S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Anv issue that mav POtentiallv affect the rank and file of aqA IDeal 3178
Issue to be lobbied (Describe in detail):
m. CITY AGENaES/INDMDUA~ TO BE LOBBIED:
A) Full Name of Individual/ntle B) Any Financial, Familial or Professional Relationship
Miami Beach camri.ssion and Mayor !'bne
Any Il'elJber of the administration !'bne
"' IV, DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $2,000 per ronth flat fee
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $2,000 per IlPIlth flat fee
The following infonnation must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
n Yes ~No: Are YOU lobbvina on a Dresent or oendina bid for aoods. eauiDment or selVices. or on a
Dresent or oendina award for aoods, eauiDment or selVice?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By lobbyists On Real
Estate Development Issues":
nYes Xi No: Are YOU 10bbvinG on a oendina aDDIication for a DeyeloDment Aareement with the CitY or
aDDlication for change of zonina maD desianation or change In the CitY's Future Land Use
MaD?
3) Pursuant to Miami Beach City Code 2-484 (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 noHor-profll:
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..
o Yes !%No: Are YOU reDresentina a not-fo....Drofit cornoration or entitY without SDeCial comoensation
or reimbursement. ,
V. SIGNATURE UNDER OAllI:
ON OCTOBER lSf OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR E PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO ENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD,
bbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provision ntained in Section 2-482 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Prindpal!Client:
VI,
LOBBYIST IDEN11FICATION:
l!YProduced ID FI 'Drv. hrr n5X:..
Form of Identification
PRINCIPAL IDEN11F1CATION:
o Produced ID
n Personally known (Lobbyist)
Form of Identification
~rsonally known (Prindpal) . 0III"lIIIiW 1IIIIIlW.
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? Rt9mIOlI fIllWOO ~~~
State of Florida, ~nty of Miami-~c:igp~u~'.9.~.~9:lr.~..~m:~.......
Sworn ~ subscritwad before me ~
ThisOl day ol.bl"'l . 20~~
;Id~~ ~ "'0 tJ~~:..J
Signature of Public Notary - State of Florida
Notarization of Principal's signature
VII, SIGNATURE AND STAMP OF NOTARY:
State of Aorida, County of Miami-Dade
Sworn to and SUbSC~efore me
This .:l V:J day ". 20.os
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Signature of Public Notary - State of Florida
Notarization of Lobbyist's signature
Annual Registration fee: [ ~/ - ] No Amount
Lobbyist Registration Fonn received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS. oc
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MCR#~7 3 ~3DatePaid I, L-~ 1)-r
Revised 12/08{04