Robert Switkes/SMG
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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, whetller 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' city personnel defined in any
manner in this section, during the time period of the entire dedsion-maldng 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 tenm 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. .
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(Last)
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BUSINESS NAME AND ADDRESS (Number and Street)
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TELEPHONE NUMBER:
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NAME OF LOBBYIST:
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(First)
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(Oty) (State) (Zip COde) ~I ~
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FAX NUMBER:
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(M.I)
EMAIL:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAl./CUENT:
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BUSINESS NAME AND ADDRESS (Number and Street) (City) f7 (State)
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TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
(Zip Code)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
.
NAME OF CHIEF OFACER, PARTtjE~ ~EN~A~~RYh (\ ~ W .
ro~ \O~/\ ~ \"<\~-~
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY. A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
.
II. SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detaltl:
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship.
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLA T RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
D Yes ~o: Are vo" reoresentino a not-for-orofit corooratiori or entity without soecial comJensation or
. reimbursement. Pursuant to Ordinance No. 2004-3435.
1)
D Yes ~:
2)
DYes io:
V.
Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2. Article VII. Division S
Thereof Entitled "Camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Procurement Issues":
Are vou lobbvino on a oresen! or oendino bid for ooods. eouioment or services. or on a oresent
or Dendina award for Goods. eauiDment or service?
Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division S
thereof Entitled "Camoaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Real Estate Develooment Issues":
Are vou lobbvina on a oendino aoolication for a Develooment Aoreement with the City or
aoolication for chanoe of zonino mao desionation or chanoe to the City's Future Land Use Mao?
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 EXP....ENDtrURES~. . ro ""0. TION D . RING THE
REPORTING PERIOD. ./ ,.... ": ~/_____~ .
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. Signarureobbylst .
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)n Sectjor( 2-48 of the Mia . Beach City Code and all reporting
requirements. /.,
Signature of Lobbyist:
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
D Produced ID
D Produced ID
Form of Identification
.r Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
Form of Identification
D Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and sUbscrib~ore me
Thl day of ~i",2a::b
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 signature
Signature of Public Notary - State of Florida
Notarization of Principal's signature
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. I FOR CLERK'S USE ONLY 2C!.' .
Annuai Registration fee: [ V] Yes [ ] No Amount pa~_a:...> MCR # ,<('2{)Date Paid
Lobbyist Registration Form received and verified b~
Revised 02/10/D4 . ER\ALL\MARIA-M\LOBBYISl\LOBBYIST FORM 04
3/23/ () t)