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Carter McDowell/Maria Pellerin A ~ "'lIImll9\IC'h 'tiff lD 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, derision, 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. NAME OF LOBBYIST: McDowell (Last) Carter (First) N. (M.I.) Bilzin Sumberg Baena Price & Axelrod. LLP. 200 S. Biscayne Boulevard. Suite 2500. Miami. FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-350-2355 TELEPHONE NUMBER: 305-351-2239 FAX NUMBER: cmcdowell@bilzin.com EMAIL: I. LOBBYIST RETAINED BY: Maria Pellerin Barcus. President & CEO NAME OF PRINCIPAL/CLIENT: Carrfour Supportive Housing. 155 South Miami Avenue. Suite 1150. BUSINESS NAME AND ADDRESS (Number and Street) Miami. (City) FL 33131 (State) (Zip Code) 305-371-8300 TELEPHONE NUMBER: 305-371-1376 FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] NAlvlE OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORA nON, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Appearing before the City Commission to protect the rights of our client. Issue to be lobbied (Describe in detail): III. CITY AGENCIESIINDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship City Commission Planning Board and Staff MIAMI 884409.17319013707 ... . . " ?V. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). No: X Are you representin1!: a not-for-profit corporation or entity without special reimbursement. Pursuant to Ordinance No. 2004-3435. 11 ~'\ ( ~ ~ Yes compensation or 1) Pursuant to Ordinance No. 2003-3393 Amending Miami Beach City Code Chanter 2. Article VII. Division 5 Thereof Entitled "Campaign Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited Campaign Contributions Bv Lobbvists On Procurement Issues": No: X Are you 10bbvin1!: on a present or pendin1!: bid for 1!:oods. equipment or services. or on a present or pendin1!: award for 1!:oods. eQuipment or service? Yes 2) Pursuant to Ordinance No. 2003-3395 Amending Miami Beach City Code Chapter 2. Article VII Division 5 thereof Entitled "Campaign Finance Reform". Via The Addition Of Code Section 2-490 Entitled 'X "Prohibited Campaign Contributions Bv Lobbvists On Real Estate Development Issues": No: Are ou lobb in on a endin a lication for a Develo ment A reement with the Ci or application for chan1!:e of zonin1!: map desi1!:nation or chan1!:e to the City's Future Land Use Map? Yes V. SIGNATURE UNDER OATH: ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECED G CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPEND S OR COMPENS TION DURING THE REPORTING PERIOD. I do solemnly swear that all of the fo going facts are true and correct and that I have read or am familiar with the provisions contained in Section 2 of the iami e h City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: o Produced ill / Form of Identification ~ Personally known (Lobbyist) o Produced ill Forrnofldentification ~ Personally known (Principal) CHR1SllNE A. BOWER MY COMMISSION # DO 344021 EXPIRES: February 20, 2006 Bonded Thru PlchIIn:llnuance ~ FOR CLERK'S USE ONLY --- Annual Registration fee:~Yes [] No AmountPaid ~ MCR# 2~'3\q Date Paid Z::f~IO<: Lobbyist Registration Form received andv~d ~ K€:5> . Revised 02/10/04 F:~ ER\AtL -M\LOBBYIST\LOBBYIST FORM 04 MIAMI 842965.1 7319011125