Loading...
Teddy Seijo/Wade Patterson m I ::gi I M'IAMIBEACH 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 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. C 4(( F BUSINESS NAME AND ADDRESS S/E 1:.10 (Last) (l(;SCJ(tC~ JSIO fE 0 Co' Y (First) BtSl{Y/JC (City) f3( V/) S(>~ ]00 (State) ]03- - ..s-7{,--<l.lLr ,.\: 2S)? TELEPHONE NUMBER: ~a5- S;7?r- FAX NUMBER: ~ c>( 0 "(..sc '~JCJ EMAIL: (M.!) Jl<{A,t{I, FL ..J:J <J? (Zip Code) r&. C 4/{c /(E-Jt://( CC. cfi -.;;: - C.:.. NAME OF LOBBYIST: (Number and Street) I. LOBBYIST RETAINED BY: '€V At' c=- r It7Jel'CJ ~ JJ NAME OF PRINCIPAL/CLIENT: (' Il.!t ~ Ilc -5 C' u/( (t BUSINESS NAME AND ADDRESS JC.r-- ~-7t-i?]tr k TELEPHONE NUMBER: 3.5 { 0 8 (..rc1 YAle ~ '- v.? ...J tJ (Number and Street) (City) 2cJ- J~.r s-7/ - Z c' (.C FAX NUMBER: (Optional) ire- ]ou (State) ;t1 C-{,tV{ f, f-' L (Zip Code) 3 )1_77 EMAIL: (Optional) Fill out this section if principal is a Corporation, 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: i!/.J- (TC;(J g CC ,NiA::>vTIo/V4 vTlIC,( try Issue to be lobbied (Describe in detail): C:-rc tv! III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship ElL ttAi Of LA cv E.1( A/~-,ttA:;...,n- .4 (}1'1 f I" i..,fr t1.1'fCft I/,{t4...A..q {Jc1cr( I/,J {(Or( (6 rV v~ Nil c;J A '"'lltcl( (1 y IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLA T RA TE OR OTHER): B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ,1' rf <-/1:tA- Y ...J;.'(f-C-It A 'f A) LOBBYIST DISCLOSURE: (Required) 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 3.No: Are YOU lobbyinG on a present or pendinG bid for Goods. eGuipment or services, or on a present or pendinG award for Goods, eGuipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": DYes Il No: Are you lobbyinG on a pendinG application for a Deyelopment 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.. 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 OR COMPENSATION DURING THE REPORTING PERIOD. G--- "'-.... ~~~st 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. Signature of Lobbyist: Signature of Principal/Client: !l~ VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: II Produced ID I Produced ID Form of Identification Form of Identification j.. Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: X Personally known (Principal) State of Florida, County of Miami-Dade Sworn to and subscribed before me ~ ~ h da of.>\0qv s..4 , 200<C State of Florida, County of Miami-Dade Sworn and subscrib d before me This %+""' of 20 eX:, .... FO Annual Registration fee: [ ] Yes [~o Am9 Lobbyist Registration Form received and verified by: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 0 .doc \ & Revised 12/08/04