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Harold Rosen / Tremont Towing r.1t.l1fTl1 th:~Atn td!kd ~ITr m - lllU3 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 prindpal who seeks to encourage the passage, defeat Dr 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, dedsion or recommendation that foreseeably will be heard or reviewed by the city commission, or a dty board or committee. The term specifically includes the principal as well as any empioyee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435, ROSEN HAROLD NAME OF LOBBYIST: (Last) 407 LINCOLN ROAD PENTHOUSE S.E. (First) MIAMI BEACH. FLORIDA 33139 (M.I) BUSINESS NAME AND ADDRESS (Number and Street) (Oty) (State) (Zip Code) (305) 534-4757 TELEPHONE NUMBER: (305) 538-5504 FAX NUMBER: EMAlL: I. LOBBYIST RETAINED BY: TREMONT TOWING NAME OF PRINOPAL/CLIENT: 1916 BAY ROAD. MIAMI BEACH. FLORIDA 33139 BUSINESS NAME AND ADDRESS (Number and Street) (Oty) (State) (Zip Code) (305) 672-2395 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAlL: (Optional) Fill out this section If principal is a Corporation, Partnership or Trust [Section 2-482 (c)l . NAME OF CHIEF OFFICER, PARTNER, OR BENEFIOARY: EDWIN GONZALEZ . IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: TOWING CONTRACT Issue to be lobbied (Describe In detail): III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: . A) Full Name of Individual/Title B) Any Financial, Familia' liD f ~~ , . " ""'':le:J ..,..,. ,,", .., : PARKING & TRANSPORATION COMMI'ITEE . f-,'-,: l .. ,", ~ ,,-' BEACI CITY COMMISSION CITY OF'MtAlU PARKING DEPARTMENT CITY OF MIAMI BI ACH 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). $350.00 an hour $350.00 an hour D Yes ~ No: Are you reDresentina a not-for-Drofit corDoration or entity without sDecial comJensation or reimbursement. Pursuant to Ordinance No. 2004-3435. 1) Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach Citv Code Chaoter 2. Article VII. Division 5 Thereof Entitled "Camoaion Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited Camoaion Contributions By Lobbyists On Procurement Issues": D Yes XI No: Are you lobbvina on a Dresent or Dendina bid for aoods. eauiDment or services. or on a Dresent or Dendina award for aoods. eauiDment or service? 2) Pursuant to Ordinance No. 2003-3395 Amendino Miami Beach Otv Code Chaoter 2. Article VII Diyision 5 thereof Entitled "Camoaion Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited Camoaion Contributions By Lobbyists On Real Estate Develooment Issues": DYes lit No: Are you lobbvina on a Dendina aDDlication for a DeveloDment 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, 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 ND EXPENDITU~SAnON DURING THE REPORTING PERIOD. ~ _ ;-;~~ .;::/ Signature of 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 contain 'n Section 2-482 of the Miami Beach City Code and all reporting requirements. ~ ~---- Signature of Lobb . ./~/ _ ~~ Signature of Principal/Client: ~/ a ~ VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: D Produced ID D Produced ID Form of Identification ij('personally known (Lobbyist) Form of Identification ~SOnallY known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: ..,,,,.~y. :~8(i> JORGE M. ROORIGUEZ ....W * MY COMMISSION. .00275581 ~ EXPIRES: December 16, 200i '\"o",r!>f>~ Bonded Thtu BudQel Hdaty Service< State of Florida, County of Miami-Dade Sworn ~and subscribed before me _ This day of ~r::1n . 20.Q'J ~)"1G.. ~ Signature of Public Notary - State of Florida Notarizati'liii_..u '. rture t (:omrIIIIlClQIIOIU : ~m~ e.-111312OCl1. . -. . - . : i'" ~i Bonded IhN (800)432-: : "{fci"~" _ Notary ,l\nn.. Inc : So M. . .II~'~~'~':......." .... ... .......... ........., FOR CLERK'S USE ONLY . - ;? L / Annual Registration fee: [ ] Yes [ ] No Amou Paid .(l(l MCR # z:l389.3 Date Paid ~ RI ()5 Lobbyist Registration Form received and verified by: Revised 02/10/04 F: CLER LL\MARIA-M\LOBBYIST\LOBBYIST FORM 04