Steve Marin/Recreational Design & Construction
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MIAMIBEACH
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.
NAME OF LOBBYIST:
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BUSINESS NAME AND ADDRESS
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(Last)
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(First)
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(Number and Street) (City)
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(State)
(M.!)
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(Zip Code)
(~S\~l \ Bl..\ 2-7-.
TELEPHONE NUMBER:
t~s.) "11\ 1,1 \\
FAX NUMBER:
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EMAIL:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAljCLlENT:
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Co "<'''''\.. <.)c..\\c,<\
'2,Qo..D N ?O(,.)e~\,'C\e... 'Q.~, y;,
BUSINESS NAME AND ADDRESS (Number and Stree!)
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(Cit,)
,,\.-
(State)
~:,>~oo..
(Zip Code)
("I~\ ~66~a~
TELEPHONE NUMBER:
(%'"1) '::,~ S~-...,S
FAX NUMBER: (Optional)
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:
(In\k \OW'::>, \:j,e:e ~e.~\~e.'(\\-
\
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
ek..e ~e.<V'.!> J '(<."'- ~,~"""-~/ "'" -r,,-- '<:'<lz.o;..)oc.. ~<'~~J~ ~
II. SPECIFIC LOBBY ISSUE:
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Issue 0 be lobbied (Describe in detail):
,
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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,
FlAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
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The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitied "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
n Yes '1 No: Are you lobbvina on a Dresent or Dendina bid for aaods. eauiDment or services. or on a
Dresent or Dendina award for Goods. eauiDment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues";
nYes ~ No:
Are YOU lobbvina on a Dendina aDDlication for a DeveloDment Aareement with the City or
aDDlication for chanae of zanina maD desianation or chanae ta the City's Future Land Use
MaD?
3) Pursuant to Miami Beach City Code 2-4B4 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-4Bl above) who only appears as a representative of a not-for-profit
corporation or entity without speciai 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..
n Yes rf1Io: Are YOU reDresentina a not-for-Drofit corDoration or entity without sDecial comDensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 15' 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 PENSATION DURING THE
REPORTING PERIOD.
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.
Signature of Lobbyist:
S
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PRINCIPAL IDENTIFICATION:
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
Form of Identification
~rSOnallY known (Lobbyist)
D Produced ID
C,' Produced ID
Form of Identification
wfersonally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
Signature of Public Notary f
Notarization of Lobbyist's signatu
IVETTE PINTO
SION #00510978
EXPIRES: FEB 11, 2010
Bondedlhrough 1st State Insurance
State of Florida, County of Miami-Dade
Sworn t d subscribed before me
This f ,4;;$ff:.. ,2
. .
..-A J"') FOR CLERK'S US~ ONL Y ">OCll~ .I--=-
Annual Registration fee:~ ,'tl;s [ ] No Amount Paict'":25!'> MCR # ~'I-~ Date Paid 2)<OJ'-"
Lobbyist Registration Form received and verified bye :a!c::l.}L~ c:::..
F:\CLER\$ALL\MARlA-M\Lobbyist\LOBBYIST fORM 05. oc Revised 12/08/04
..
Miscellaneous Cash Receipt !_I...Jf'L1.;.-..(.. ",,",...:.."_, ....,LlUo!:LlJel LIlli q
MCR-Citv Cl~fk 288748 $25.00
CITY OF MIAMI BEACH . 2e874~:)
No.
CJ Cash CI Credit Card ~eck # 31 ~:5"-:r_ $25~<:)
2--.::0 2QC::) '-::}-
Received of Mo...D ("'\ ~ ~'S., ~c..,
Add...
For A) eVe.- tv\~n.-
,
(THIS INFORMATION MUST BE COMPLETED) OffIce ~ ~nance Director
By , .
Account Number: () \ \ -?c>CX:r 'J.!..n -444 ~I j
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Preparer.J-'1. ~ Dept: r' t--\.u C . EXT~\\
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