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Maria Pellerin Barcus ~~e~ City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 ** AMENDED** 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, decision, recommendation of the City Manager or any city board or committee; or any action, decision or recommendation of any city personnel 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 Sumbera Baena Price & Axelrod LLP 200 S. Biscavne Blvd. Suite 2500 Miami. Florida 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 PRINCIPAUCLlENT: Carrfour Supportive Housina. 155 South Miami Avenue BUSINESS NAME AND ADDRESS (Number and Street) (305) 371-8300 TELEPHONE NUMBER: FAX NUMBER: (Optional) Miami (City) FL (State) 33131 (Zip Code) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] . NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: . IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Land Use applications pertainina to Hardina Villaae. Hardina Avenue & 86th Street. Miami Beach III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of IndividuallTitle B) Any Financial, Familial or Professional Relationship . Planning Board, Victor Diaz, Chairman, and other members; City Attomey, Murray Dubin, Assistant, None City Attorney; Gary Held and staff; Planning Director, Jorge G. Gomez and staff; Zoning Board of Adjustment, Jason Loeb, Chairman, and other members; City Manager, Jorge Gonzalez and staff; Mavor, David Dermer and City Commissioners. IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER) A) LOBBYIST DISCLOSURE: (Required) $425 per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $425 per hour The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": DYes" No: Are you lobbying on a present or pending bid for Goods, equipment or services, or on a present or pending award for goods, equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate . Development Issues": o Yes~ No: Are you lobbying on a pending application for a Development Agreement with the City or application for change of zoning map designation or change to the City's Future Land Use Map? 3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of "lobbyist" as set forth in Section 2-481 above) who only appears as a representative of a not-for-profit corporation or entity without special compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any item, shall register with the clerk as required by this section but, shall not be required to pay any registration fees.. o Yes)a No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement. 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 SHA E FILED EVEN IF RE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PE Sig o Produced ID PRINCIPAL IDENTIFICATION: I do solemnly swear that all of the foregoi contained in Section 2-482 of the Miam. ea Signature of Lobbyist: Signature of Principal/Client: VI. o RDlsON roduced ID Form of Identification . ;....;;l~ ~~7 ersonally known (Principal) .., .", -.:0 & Bondng, Inc. VII. SIGNATURE AND STAMP OF FOR CLERK'S USE ONL Y Annual Registration fee: [] Yes [ ] No Amount Paid MCR# Date Paid Lobbyist Registration Form received and verified by: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST FORM 05.doc Revised 12/08/04 :W: HOWS R. HARDISON !!W MY COMMISSION # DD0!3444 t:t't" ",' . EXPIRBS: hnua., to. D6 1-8OO-3-NOTAAV FL NotIfy SeMae" ~ tnc.