C. Robbins/Gay & Lesb. Task FrcFROM
FAX NO. : Oct. 24 2~5 10'l-~qM P2
City of MiBmi Beach ~~bAhe ~C~ik
700 Convention Center ~i~ ~ ~C~r~[ ~3139
LOBBYI~ REGISTRATION FORM
Lobbyist means all persom employed ar retaned, 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
Oty Manager or any city board or committee; or any aCtion, derision or recommendation d any dty personnel during me tim~
period of the entire decision-making process on such action, decision or recor~mendation U'tat foref~eably will be heard or reviewed
by the city commission, or a dry board or commRtee. The term specifically indudes tJ'~e prlndpal as well as any employee
/n lobbying activities. The term "Lobbyists" has ipectflc exclusions. Please refer to Ordinance 2004~3435.
I I I IJ IJ ............ I I ........ - .... ' '__ .....
BUSINE.~S NAME AND"~s - ........... (Number and ~t) (aW) (State)
~A,i~oN~- N~R: ........ ~.U~R: ..... '-"
Z, LOBBYIST RETAZNED BY:
N,4~E OF PRINcJPAJ~[C[/j~NT:
BUSINESS N~E AND AD~ (Numar and ~eet) (OW) ($~te)
(Zip
Fill out this ~ If principal is a Corporation, Partnership or Trust [Section 2-4B2 (c)]
· NAME OF CHIEF OFFICER, PARTNER, OR BENEFICLAR¥:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR IVIORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
SPECTF/C LOBBY %55UE:
'[~,~ue 1~o be lobbied (Deso'lbe In detail):
%I%. ~ AGENC/ES/TND[V%DUALS TO BE lOBBIED:.
A) Full Name of Zndividual/Title
B) Any PinartdaL Familial or Prefesslenal RelaUenshlp
FAX NO. ' Oct. 24 2005 10'I?AM P3
[] Yes
~_u~nt toOrdinnnce #~. 2Q133-3311)3..Amendln_a Miami Be~ch Ci~ C~e_Cha.~e.r 2,.__.A~.._cle V][], Division_S
Thereof EntJrled?_Camoaign FinarJCe Refo .r~..; ~ .T, he ~zldltton O~ Code S~'~ja.' n
Cam.aalq. n Con~ ._buttons Ih: Lol~bv_i_._s~s On ,procurement ]...~ues':
Are you Iobb_v!.n_. ~ a m~ent ~_r oendip~_'.bid for aero,s: e~,_uimnent_or
..or amdlna mw~r4 for aoad~, ~_ .iament or ee _wice? -
2) Pursuant to Ordlnanoe No. 2003-3_3g~ Amendlna Mlar~i Bea~LCItv Code Ch..a_n~e__r
U3e[eof EntlUed ,_Ca_. maaian Mnanc~...._Reform", Via Th_e Addition of.Code ga~_~lOn 2~gO_[a'TtiUed 'P~ohlbiterl
gam~aion ContribuUons Bv,t.o~_ Ists ..On Real F.~ate Deveiql;~nent..!ssues#:
i]~ea'~l/No: , Are you Iobbvina ~ a _ae.n_di#a aa_~l!catlon for I.Dj,~.,le_~maatAg__reement With the City. or
/" ~.gpllcaUo_ n for ~an_.e .0.f zanina ~q,lD deaianati~n or eh_anae t~.the (3 _t~,t Fubsra La#d ~m~ Map?
V. SZGNATURE UNDER OATH=
ON OCTOBER ].~' OF EACH YEAR, EACH LOBBYIST SHALL SUBMZ'r TO THE CZTY CLERK A SZGNED
STATEMENT UNDER OATH, I.~STZNG LOBBYZNG EXPENDZ'ruREsw AS WELL AS COHPENSATXON
RECEIVEDr ZN THE c:TrY OF H/AH! BRACH FOR THE PRECEDZNG CALENDAR YEAR. A STATEHENT
SHALL BE IrZLED EVEN IF THERE HAVE BEEN NO EXPENDZTURES OR C:O~PENSAT~ON DURING THE
REPORTZNG PERIOD. ~
_._
'~ture of
! cio solemnly swear that all of the foregoing filL'tS are lzue ilnd correct and I~t ! have re. ad or am
familiar with the provisions contained in section ]J-,t82 of the Miami Se. ach CiLy Code and alt reporting
Signature of Lobbyist: .k~'/.d~u~J./~ ,,
--
VZ, LOBBYZ~r ZDENTZPZCAI'ZONI PIKNC:ZPAL IDENTZF~CATEQN;
0 Personally known (Lobbyist) o Personalv known (Prlndpll)
VIZ. S~GNATURE AtlD ~P OF NOT. Y='
S~ of Fior~, ~un~ of N~mI-Dade ~ $~e of FI~, Co~ ~ N~mi-~de
5~m ~ a~ ~~d ~fom me
~ls ~day~ 9f ~~. · 2~.
~h~~ ~J ~n~ ~mj N ~:- -: ::: .... ~-
' ~?. ~ KERRY HERNANDEZ
~t ~.~ EXPtRES. ~y 3, 2~07 . JJ ' ~ ':~" ~:j~T:; Bonde, Th~u Notaw Pub,J~ Under,rets' J J
R~ 0~I10/~ F:~R~LL~-M~L~B~LOBB~ FO~ 04