Harold Rosen/Mama Vieja LLC
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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" city personnel defined in any
manner in this section, 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 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. Please refer
to Ordinance 2004-3435. .
,
NAME OF LOBBYIST: (last) (First) (M.I)
Rosen Switke$ & Entin P.L. 407 Lincoln Road PH SE, Miami Beach, FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 534-4757 (305) 538-5504 hrosen@rosenandswitkes.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
ROSEN,
HAROLD
I.' LOBBYIST RETAINED BY:
Mama Vieja LLC
NAME Of PRINCIPAL/CUENT:
1691 Michigan Avenue, Suite 325, Miami Beach, FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 695-0288 (305) 695-0284
'TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out .this section if principal is a c;orpor~tion, Partnership or Trust [Section 2-482 (c)l
· 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:
Application for Conditiona~ Use Permit
Issue to be lobbied (Describe in detail):
",
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
Planning Board
.
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. ~ ,.. .
No.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER): .
A) LOBBYIST DISCLOSURE: (Required)
$350.00 hourly
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
$350.00 hourly
DY s
1) Pursuant to Ordinance No. 2003-3393 Amendinq Miami Beach City Code Chaoter 2, Article VII, Division 5
Thereof Entitled "Campaign Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Campaiqn Contributions By LobbYists On Procurement Issues";
No:
2) Pursuant to Ordinance No. 2003-3395 Amendinq Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaiqn Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaiqn Contributions By Lobbyists On Real Estate Develooment Issues";
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THl: PRECEDING
SHALL BE FILED EVEN IF THERE HAVE BEEN EXPEN
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
reql,Jirements.
VI.
LOBBYIST IDENTIFICATION:
\
Signature of Lobbyist: /'~.
#'
Signature of Principal/Client
PRINCIPAL IDENTIFICATION:
o Produced 10 0 Produced 10
'I: . Form of Identification Form of Identification
Personally known (Lobbyist) ~ersonallY known (Principal)
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V.' SIGNATURE AND STA %*:,' '~~Y~~ls~i~n #DD28720~
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State of Florida, County of Mlamh"'Q~F~~" Bonded Thru State 0 F on a, ounty 0 laml- a e
Swor I ~md subsc' e ef1 r me "7"\\Y\~"'f.t1antic Bonding Co., Bworn ~np,_subscribe~ 1>e~ore me
. I I ayof '2rJ-1'f-( This ~'tJay of :rU "! ~ , 20~ b
. FOR CLERK'S USE ONLY . " ~
Annual Registration fee:., { ] Yes ( ] No Amou~~\~ Date Paid c.ol
Lobbyist Registration Form received and verified by:
Revised 02/10/04 ~ER\ALL\MARIA-M\LOBBYIST\LOBBYIST FORM 04