Harold Rosen / Terranova Corp
~lt:JfT11 ~e.m;h
~
iijji.'
m
laC3
-
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 dedsion of any commissioner; any action, decision, recommendation of the
City Manager or any dty board or committee; or any action, decision or recommendation of any dty personnel defined in any
manner in this section, during the time period of the entire decision-making process on such action, decision or recommendation
tihat foreseeably will be heard or reviewed by the city commission, or a dty board or committee. The term spedfically includes tihe
principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer
to Ordinance 2004-3435.
, ~~X', \A'f=:)\).f) \0
NAME OF LOBBYIST: (Last) (First)
..L\()'1 1-~ "\Ie])'" \l.A '\)y\~p \Y\"''0\''''~ \?xc-;e('~
BUSINESS NAME AND ADDRESS (Number and Street) (Oty) (State)
(3Cf5')53%'-65~
EMAlL:
(M.I)
~\ ~~\~q
(Zip Code)
TELEPHONE NUMBER:
( ?i)~ ') 53ct - Z\ 15 '\
FAX NUMBER:
I. LOBBYIST RETAINED BY:
\E-~~'A 0,()~ po.
NAME OF PRINCIPAL/CLIENT:
(' ()v..v() y.,~-\ ~(}'<\
c~ \=\)h'--.j\J-.d-
(Number and Street) (City)
C3U)) lA6- ~ 'JDO
TELEPHONE NUMBER: FAX NUMBER: (Optional)
<60 \ A v... '\-\;v.. 1 ^
BUSINESS NAME AND ADDRESS
'\Y'\\0_\fY\', ~rC h ~\ 3:3\2:8
(State) (Zip Code)
EMAlL: (Optional)
Fill out this section if prindpal Is a Corporation, Partnership or Trust [Section 2-482 (c)l
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
Patricia M. Blasi, Eiecutive Vice President, Terranova Corporation
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
'-l. ~V-.\ ("_0.(' c::. ~Dv.... ~\~"" / \(...,C:{}~\~ 6\~n:":h.J~j
Issue to be lobbied (Describe In detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Finandal, Familial
r\-\-
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
1)
Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach Citv Code Chaoter 2. Article VII. Division S
Thereof Entitled "Camoaion Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaion Contributions Bv Lobbvists On Procurement Issues":
2)
Pursuant to Ordinance No. 2003-3395 Amendino Miami Beach Citv Code Chaoter 2. Article VII Division S
thereof Entitled "Camoaion Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaion Contributions Bv Lobbvists On Real Estate Develooment Issues":
DYes ~o:
Are YOU lobbyina on a !>endina aDDlication for a DeyeloDment Aareement with the City or
aDDlication for chanae of zonina maD desianation or chanae to the City's Future Land Use MaD?
V.
SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LImNG 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 EXPENDITURE COMPENSATION 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 Se 'on 2-482 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
o Produced 10
o Produced 10
Fonm of Identification
~rSOnallY known (Lobbyist)
Form of Identification
)? Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This.3 day of \=<;JJj . 20I:tS
% U...>O... 0.(1 MJL~
Signature of Public Notary - State of Florida
Notarization of Lobb . . nature
Signature of Public Notary - State of Florida
Notarization of Principal's signature
""'~::"" Colette Rick
/i'.~' .~~ Commission #OD303868
=*;~ :*;: Expires' Mar 25 2008
-~. ~'J" . ,
-=-....~}.;O;f\.O~.:... ~nded.Thru
'1/111\\\ AtlantIC BondLng Co.. lnc.
. ==:'
. ...... ",,(IlICI)ol~ .
. !rJ:i ~.~~.;.~.i
..................
/" FOR C
Annual Registration fee: [ ---rYes [ ] No Amou t Il i
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F