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Bea Kellehek/Spiegel LP, Ross Mollison lD "WI' MIAMlB City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRA nON 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 specifie exclusions. Please refer to Ordinance 2004-3435. KLGL[HU<: NAME OF LOBBYIST: ,6~ (Last) (First) 22- W l41;.,:)tve.ct ~ Ltov'~ ~'l l . (Number and Street) (City) (State) 'LlL C,31 eLL" fce~~@~_~ FAX NUMBER: EMAIL: (M.!) [eDl( (Zip Code) Sf ('i.Go Ut.. L f BUSINESS NAME AND ADDRESS Z.-l z... '2.4-5" IOD'9 )c ZD-S TELEPHONE NUMBER: I. LOBBYIST RETAINED BY: NAME OF;~N~~E~P R n,)S H~O,,^- 2..2. ~. I c;. Sc- (Number and Street) ~ ()K- (City) NY (State) /ooU. (Zip Code) 2-t"L 74-5' 100 ') TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAlL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (e)] . NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ~ -1"'"'.0 L...-'-l 5.O-......J . IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ~5 ~~L-L.-l>~ I Vt:\-L..LE:"~ t\.~~ II. SPECIFIC LOBBY ISSUE: _ \:0 I.oe...-~o~ . . . S?I..e~LJA.!~ ~ f$N .~I Mc-v- '01- tro.- \ov',",,^~ ~'::J ~ Issue to be I bied (Describe in etail): -t;o ~ ~c:.-L--. _ Co~~ ~. . III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship GM \leA f'Jo M~ vcA NO IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER). A) lOBBYIST DISCLOSURE' (Req.......) N<M... ,~ ..;A . ""'^ ~ ".In./ '1 - 0--- ~ ~<- "- B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (ReqUired).~ 7 - ~ . . ' ~ The following information must be answered: ~ ~ (,.t~ 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": ;,.- jNo: Are YOU lobbyinG on a Dresent or DendinG bid for Goods. eGuiDment or services. or on a Dresent or DendinG award for GOods. eGuiDment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": DYes "No: Are you lobbyinG on a DendinG aDDlication for a DeyeloDment AGreement with the City or aDDlication for chanGe of zoninG maD desiGnation or chanGe to the City's Future Land Use MaD? 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.. DYes 1 No: Are you reDresentinG a not-for-Drofit corDoration or entity without sDecial comDensation 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, USTING 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. {2.p~ lee LL(?~ Signature of Lobbyist 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. VI. Signature of lobbyist, ~ ~ SignatureofPlindpal/Oient, nl. ~ .. %Jd~, LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: --- ~cedID P&;....':,<::'?ovk:' ~ucedID~.f1cu~ VroOL Form of Identification Form of Identification ~' , D Personally known (Lobbyist) D Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn and subscrib~d ore me This ..!t!fj;day of (), 5;9'& li~ 0 Notarization of Pri ~ % ?Jt Date Paid FOR CLERl<'S USE gNL Y Annual Registration fee: [ ] Yes [ ] No Amount PaidA / ~~5::" MCR # Lobbyist Registration Form received and verified by: d V~ F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.d Revised 12/08/04