Thomas Gould/Eric Martinez
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City of Mi1a:frfiLBea&l{)Orfi~e of the City Clerk
1700 Convention Center Drive, Mia111i 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 proccss on such action, decision or recommendation
that foreseeably will be heard or reviewed by the city commission, or a city board or committee. The :erm 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.
GOULD
NAME OF LOBBYIST:
(Last)
THOMAS
(first)
R.
(M.I.)
Bilzin Sumberg Baena Price & Axelrod LLP, 200 So. Biscayne Blvd.. Suite 2500, Miami, Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-350-7234
TELEPHONE NUMBER:
305-351-2279
FAX NUMBER:
t~ould((ubilzill.com
EMAIL:
I. LOBBYIST RETAINED BY:
ERIC MARTINEZ.
NAME OF PRINCIP ALlCLIENT:
1330 Bay Drive
BUSINESS NAME AND ADDRESS
Miami Beach
(Number and Street)
FL
(City)
,(State) (Zip Code)
305-825-9090
TELEPHONE NUMBER:
(305) 825-9440
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (e)1
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5'% OR MORE
OWNERSHIP INTEREST IN SUCH CORI)ORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Appearing before the Planning Board - ~Dl)rJJ)iO,Ja. J U0-c a (JfYDVtl J tor'" /35 U ~ A~,
Issue to be lobbied (Describe in detail): J
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Anv Finanei.~' Familial or Professional Relationship
Plannin~ Board NONE
Planning and Zoning Board NONE
--------.
MIAMI 901934.17601521440
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE
WHETHER HOURLY, FLA T RATE OR OTHER):
A)
B)
LOBBYIST DISCLOSURE: (Required)
$260/per hour
PRINCIP AL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
$260/per hour
Yes No: X Are vou representin2 a not-for-profit corporation or entitv without special compensation or
reimbursement. Pursuant to Ordinance No. 2004-3435.
I) Pursuant to Ordinance No. 2003-3393 Amending Miami Beach City Code Chapter 2. Article VII. Division
5 Thereof Entitled "Campaign Finance Reform" Via The Addition Of Code Section 2-488 Entitled
"Prohibited Campaign Contributions By Lobbvists On Procurement Issues":
Yes No: X Are vou Iobbvin2 on a present or pendin2 bid for 200ds. eQuipment or services, or on a present or
pendin2 award for 200ds, equipment or service?
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
"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues":
Yes No: X Are vou Iobbvin2 on a pendin2 application for a Dev('(opment A2reement with the City or
application for chan2e of zonin2 map desi2nation or chan{!e to the City's Future Land Use Map?
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 COI\iIPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDfNG CALENDAR YEAR, A STA TE:VIE!\'T
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPEN URES OR COMPENSA T N DURING THE
REPORTING PERIOD.
1 do solemnly swear that all of the foregoing facts are true and correct and that 1 have read or am amiliaI' with the
provisions contained in Sec. 2 82 of the Miami Bach City de and all re orring requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
PIUNCIPAL IDENTIFICATION:
o
Produced ID
Fotn1ofldentitication
iJ
Produced 10
Form of Identitication
u/
Personally known (Lobbyist)
IJ
Personally known (Principal)
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,20Q1
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This _ day of ,20_
Signature of Public Notary - State of Florida
Notarization of Lobbyist's si nature
Signature of Public Notary - State of Florida
Notarization of Princi )al's sionature
c.',,,,!
..~~~~ MERCEDES PADRON
. :*~ MY COMMISSION # DD 1508(,1()
':,:;....i1/ EXPIRES: November 9, 2006
:.':~..;~ Bonded Thru PioIlard Insu..""" Agency
C~ .2.~(Q FOR CLERK'S USE ONLY
Annual Registration fee;'~,Yes [] No Amount Paid.25.00 MCR #.L"i=1~ Date Paid f.oI2So./V
Lobbyist Registration Form received and verified by: ~~
Revised 02/10/04 F: CLER\ALL\MARI'A-M\LOBBYIST\LOBBYIST FORM 04
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City of Miami Beach Office of t11e City Clerk
1700 Convention Center Drive, Mimni Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist meClm all persons employed or retained, whether paid or nOl. by a principal who 5e~I(~ ro enCourage tll~ poss",!;e, defeat
or modification of any ordinance. resolution. a~tion or decision of any comrl'li$sioncr; MY action, derision, recommendation of
the City Managcr or any city board or cOmmittee; or any action. decisiOn or recommendation Of :my 'ity plolrsonlld defined ill uny
manner in this Section, ciuTing the time period of :hc e:'I!irc: decision. making precess on sucb aClion, d~cision or recommendation
that foresccably will be heard Or reviewed by t.ie city cOTTl1nission, OJ' a ciry board or cumminee. Thl! :t=nn specificall)' inelude~
the pril1cipal as well ~ any employee engaged in lobbying activities. The term "LobbyiSts" h:l.s specific exclusions. PIC:lse ref\:r
to Ordim,"ce 2004-3435.
GOUlD
NAME OF LOBBYIST:
(Last)
THOMAS
(Firsr)
It
(MJ.)
Bilzil1 Sumbel't? Baena Priec & Axelrod LLP, 200 So. Biscavne Blvd" Suite 2500, Miami. Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (lip Code)
305-350-7234
TELEPHONE NUMBER:
3D5-351-2279
FlU:: NUMBER;
tgould(cvbilzin.com
EMAIL:
L LOBBYIST RETAINED BY:
ERIC MARTINEZ.
NA..1IvfE OF PRlNCIP AL/CLIENT;
1330 Bay Drive
BUSINESS N.Al\iIE AND ADDRESS
Miami Beach
(Number and Strcet)
Fl
(Cily)
- (Srate) (Zip Cod.:)
30S-825-9090
TELEPHONE NUMBER:
(305) 825-9440
FAX NUMBER: (Optional)
EWu\IL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Tryst [Section 2-482 (c)l
NAME OF CHIEF OFFICER. PARTNER, OR BENEFICIARY;
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDlRECTL Y, A 5% OR MORE
o\VNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST;
II. SPECIFIC LOBBY ISSUE:
A earinl:' before the Plannin Board
Issue to be lobbied (Describe in detail):
III. Cn'Y AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Fulll'lume of Individual/Title B) A.ny FinaJlcial, l'amilial or I'rofessional Relationship I
Planniug Board NONE I
Plannin2 and Zoning Board NONE I
- ~
!
,
, MIAMI 90l934.1 7601521440
. rv. DISCLOSURE OF TERMS AND A.\10UNTS OF LOBBYIST COMPENSATION (DISCLOSE
WHETHER HOURLY, FL.r\ T RATE OR OTNER):
A)
B)
Ye!O
1)
Yes
2)
Yes
LOBBYIST DISCLOSURE: (Required)
$260/per hour
PlUNCfPAL'S DISCLOSURE (OF LOBBYIST COMPENSA TrON): (Required),
j260/p~/, hOUI'
or
Pursuanr 10 Ordinance No. 2003-3393 Amelldin~ Miami Beach CilY Code ChaOT::r 2. Article VII. uivislOll
5 Thereof Entitled " , Tn <'Ii .1 Finance Reform" Via Tl1.: Addirion Of Code Section 2-488 Entit)~d
"Prohibited Campaign Contributions Bv LobbYists 01: Procur~mcnt rssu~: ~
Pursuant to Ordinanc(l :\To. 2003-3395 Amending Miami Beach City Code Chapter 2, Ani<::!e VII Division
5 thereof Entitled "Camoai~n Finance Reloml", Via The Addition Of Code Section 2-490 Entitled
"Pr(lhibilt!d Campaign Contributions By Lobbyists On Real EsTate D~vd(mment Tssues";
City or
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EA.CH LOBBYIST SHALL SUBMIT TO THE ClTY CLERK SIGNED
STATEMENT UNDER OATH. LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATIO!\'
RECEIVED, IN THE CITY OF MIA1VlI BEACH FOR THE PRECEDING CALENDAR YEAR. A STA l'EMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPEN URES OR COMP ENS AT N DURING THE
REPORTING PERIOD.
Signature of Lobbyist:
Signature of PrincipaL/Client:
VI. LOBBYIST IDENTIFI
o
Produced ill
Form ofIdenlifi atian
~
Personally known (LObbyiST)
Signature of Public Notary - Start of Florida
Notarization oj' Lobbvist's si natUl"e
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MEIlCEoes PADRoN
AlY COIVMISSIOO tOO 150800
EXPIRES; NoV&mtl6r 9 2lJOt;
IlMdocrThIU P'l<'hord"'.~_ Agooney
/
~
Produced ID Dr-I J.tI\~ \i H,.,j~e.
Form ofldentificaTioll
Per:;onally known (Principal)
I
I
j
I
I
l"OR CLERK'S USE ONLY
An:1Ual.Regi5lratiOll fec: [J Yes (J No Amount Paid MeR #
Lobbyist Registration FOlm received aod v~ified by:
Rc\;ised 02/10/04 F: CLER'ALL\.\o!ARIA-M\LOBBYTST\LOBBYIST FORM 04
Dale Paid
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