Harold Rosen / Manny Diaz Jr.
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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
or 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' dty 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 dty commission, or a dty board or committee. The term spedfically includes the
principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specifiC exclusions.cPlease refer
to Ordinance 2004-3435. ' =i g
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.ROSEN HAROLD
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NAME OF LOBBYIST: (Last) (First)
ROSEN SWITKES CABRERA & ENTIN 407 LINCOLN ROAD,PHSE.
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
(305)534-4757 (305) 538-5504
TELEPHONE NUMBER: FAX NUMBER:
EMAlL:
I. LOBBYIST RETAINED BY:
MANNY DIAZ JR.
NAME OF PRlNOPALjCUENT:
BROTHER VENDING INC.
BUSINESS NAME AND ADDRESS
17200 N.W. 2nd COURT, MIAMI, FL 33169
(Number and Street)
(Oty)
(State)
(Zip Code)
(305) 553-8388
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
EMAlL: (Optional)
Fill out this section If principal is a Corporation, Partnership or Trust [Section 2-482 (cn
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFIOARY:
MANNY DIAZ JR.
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
ANSWER TO OUR RFP 09~Q405
Issue to be lobbied (Describe in detail):
III. CITY AGENCES/INDIVIDUALS TO BE LOBBIED:
.,.,," , . ., .,.., .. .,
A) Full Name ofI,ndivldual/TltI. 'If ~ ' , ....-,t B) Any Financial, familial or Professlona'l Relatio~hlp
, .... ',' "
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SELECTION COMM.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
$450.00 an hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 4 c; 0 00 a n hour
DYes [j{No: Are YOU reoresentinG a not-for-orofit corooration or entity without soecial comJensation or
reimbursement. Pursuant to Ordinance No. 2004-3435.
1)
Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions Bv Lobbyists On Procurement Issues":
D Yes GrNo:
Are YOU lobbyinG on a oresent or oendinG bid for 900dS. eauioment or services. or on a oresent
or oendinG award for Goods. equioment or service?
2)
Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Campaion Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions By Lobbyists On Real Estate Develooment Issues":
DYes :&I No:
Are YOU lobbyinG on a oendinG aoolication for a Deyelooment Aqreement with the City or
aoolication for chanGe of zoninG mao desiGnation or chanGe to the City's Future Land Use Mao?
V.
SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING 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 0 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 Section 2-482 of the Miami Beach City Code and all reporting
reqUirements.
LOBBYIST IDENTIFICATION:
ENTIFICATION:
Signature of Lobbyist:
VI.
D Produced ID
D Produced ID
Form of Identification
~ersonally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and SUbSCri~ me _
. This \~ day of . 20fJ:::>
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Signat.,...[iublft:~gtt~"""'rida
NotarlJEa~JQy~',1ltto~&HiRR~tute
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State of Florida, County of Miami-Dade
Sworn and subscribed bef~e _
This ~day of r\....u.. 2~
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Signature of Public Notary - State of Florida
Notarizatf6......m"PtUtJ~n........!
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Annual Registration fee: . (L--rYes [ ] No Am MCR t277..? ~ Date Paid
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F. LE \A MARIA-M\LOBBYIST\LOBBYIST FORM 04