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Stephen Moss / IHC ~.\o. ;"'--. ~('.;. ') t:xox.t ~iiP m 2;...U... 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, dedsion, recommendatIon of the City Manager or any city 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 that foreseeably will be heard or reviewed by the dry 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 Orcinance 2004.3435. NAME OF LOBBYIST: Moss (Last) Stephen (First) B. (M.I) Holland & Knight LLP I One E. Brcward Boulevard, Suite 1300, Ft. Lauderdale, FL 33301 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 954-525-1000 TELEPHONE NUMBER: 954-463-2030 FAX NUMBER: stephen.moss@hklav rom EMAIL: I. LOBBYIST RETAINED BY: IHC;Miarri Beach CarpJratian NAME OF PRINCIPAL/CLIENT: 1950 Stemrons Freeway, Suite 6001r Dallas, Texas 75207 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 214-863-1285 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal 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 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION. PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Challenge to p?ssib1e designation .of Wyndham Hiami Beach Resart Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship Jorge Gomez, Director .of Planning None - William Cary, Director, Design, PrE :oervatian and Neigh1::orhood Plarming Di Iv I 'lhanas I>boney, Design and Preservation ~1anager None isian - None Historic Preservat~on Board - Nane Plarming Board - None City Commissian and Staff - None IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WH!THER HOURL Y, FLAT RATE OR OTHER): Hourly $395.00/hour Hourly $395.00/hour A) LOBBYIST DISCLOSURE: (Required) _ Yes B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ~ Are vou reDresenting a not-for-Droflt corDoration or entity without soecial comDensation or . bursement. Pursuant to Ordinance No. 2004-3435. 1) Yes (;) 2) Yes 9 v. Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach City Code Chaoter 2. Article VII. Division 5 Thereof E~titied "Ca moaion Rnance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited Camoaign Contributions Bv Lobbvists On Procurement Issues": Are vou lobbying on a Dresent gr oending bid for goods. eauiDment or services. or on a Dresent or oendlng award for goods, eaulDment or service? pu:~~nt to ~inance No. 2003-3395 Amendino Miami Beach Citv Code Chaoter 2. Article VII Division 5 th r f Entitl "Camoaion Finance Reform". Vla The Addition Of Code Section 2-490 Entitled "Prohibited Camoalon Contributions Bv Lobbvists On Real Estate Develooment Issues": Are YOU lobbying on a Dending aDDlication for a DeveloDment Agreement with t~~ or aD~Ii~tion for change of zoning maD designation or change to the City's Future Land Use MaD? SIGNATURE UNDER OATH: ON OCTOBER 1ST OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, UmNG LOBBYING EXPENDITURES, AS WELL AS COMPENSAnON RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. /~ ..zs. , Signature or Lobbyist ~ 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 Section 2-482 of the Miami Beach City Code and all reporting requirements. Signatu re of Lobbyist: Signature of Principal/C1ien't: VI. LOBBYIST IDENTIFICATION: PRlNCIPAL IDENTIFICATION: o Produced ID o Produced ID Fonn of IdentifICation Form of Identification ~ Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: ~ Personally known (Principal) State of Florida, County of Miami-Dade Sworn tQ and subscribed before me This '1~ day of. Fe.-h rv.<Y!if 20l2..5 ~IiC Notary - State' orida Notarization of lobbyist's signa ure State of~, County of ~ Sworn i}J}d subscr~d before me This ..LLday of. 20b5 ElAlNE STARlING MY COMMISSION # DO 110866 EXPIRES: April 22, 2006 Ioni8d Thru Notary Public UndeJWriters Annuai ReQistration fee: [~ ] No Amo Lobbyist Rl!\llstration Form received and verified by' Revised 02/1 0/04 SE ONLY ;''2 Pcr- , MCR r5!.<:;J'V Date Paid \MARIA-M\LOBBYIST\LOBBYIST FORM 04 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). Hourly $395.00;hour Hourly $395. OO;hour 1) Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach Citv Code Chapter 2, Article VII. Division 5 Thereof Entitled "Campa ion Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited Campaion Contributions Bv Lobbvists On Procurement Issues": 2) Pursuant to Ordinance No. 2003-3395 Amendino Miami Beach Citv Code Chapter 2. Article VII Division 5 thereof Entitled "Campaion Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited Campa ion Contributions Bv Lobbvists On Real Estate Development Issues": Yes V. SIGNATURE UNDER OATH: ON OCTOBER 1ST 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 THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature OT Lobbyist 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 Section 2-482 of the Miami Beach City Code and all reporting requi rements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: o Produced ID o Produced ID Form of Identification Form of Identification jl Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: ~Personally known (Principal) State of Florida, County of Miami-Dade Sworn to. and subscribed before me This day ok _---' 20~ T<:-~ p~s. State of FIorftja, County of Mia . ai:lt:: Sworn ~lJd subscr~ before me This lLday of 20t:f) - - Signature of Public Notary - State of Florida Notarization of Lobbyist's signature FOR CLERK'S USE ONLY Annual Registration fee: [ ] Yes [ ] No Amount Paid MCR # Date Paid Lobbyist Registration Form received and verified by: Revised 02/10/04 F: CLER\ALL\MARIA-M\LOBBYIST\LOBBYIST FORM 04