Jennifer Ferreri/Bera, Stearns & Co, Inc.
lb
.....
MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, Fl33139
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.
Fe rre(" ~ :r e.r\f\ ~ ~e ('
NAME OF LOBBYIST: (Last) (First) (M.!)
'Bear. S1e.a.rA6 '"G.~. ;,)0)5 ~1zrt.r8hJ..~~I~cctO^ PL 33l{3'L
BUSINESS NAME AND ADDRESS (Number and Street) (Oty) (State) (Zip Code)
5' I {,7?Jfqt~ j kr,e.r: (lJ ~t' tCOm
FAX NUMBER: EMAIL:
5~J '?24gGO
TELEPHONE NUMBER:
I. LOBBYIST RETAINED BY:
&a. f. 5ko.. f" t1 ~ ~ G -:J::n. c ~
NAME OF PRINCIPAl/CLIENT:
3g'3 Mo.d ~SO(\ Ave... tvaw ~ {)('l,-
BUSINESS NAME AND ADDRESS (Number and Street) (City)
'2-t 2- 212- U)()o g 73 7q 3-zZ l/ Y
TELEPHONE NUMBER: FAX NUMBER: (Optional)
d It) 17Cf
(State) (Zip Code)
..s-/-hQ~ Q. bRa r- ( Co
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:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: ''/ .. I I I 1_
-rF\e- &a.f' 64eo. rn.5 (3)'(Y)~" ~S:Jnc. 100 If) sna.1't: ~ll \..CULt"
II. SPECIFIC LOBBY ISSUE:
M Uf\lC-l pt t bor"ld. ~ t-el 't- W ~ r\a.t\C:.Lct I 3er./l.us
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
IV. DI!;CLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLATRATEOR OTHER): J. ~ f- . l' _ ~a.seJ
A) LOBBYIST DISCLOSURE, (..."0....) of I\(r I J (5cre I 0"" ':':3 COm peD~ p6'~~ rt;.. ~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). o~he.f - d 1 5 ere..+, otl a r c.4 ~ht~(\m
-..:fA
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":
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
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..
o Yes ~o: Ar~~ou reoresentina a not-for-orofit corooration or entity without soecial comoensation
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, 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 EXPEN RES OR COMPENSATION DURING THE
REPORTING PERIOD.
I do solemnly swear that all of the foregoing facts e true n correct and that I have read or am
familiar with the provisions contained in Section 2-482 of the lami Beach City Code and all reporting
requirements. df
Signature of Lobbyist: ~~
Signature of Prindpal/Client: n ._j (; .. .. .
pc ri- E Pont \A
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
:I Produced ID
fj Produced ID
Form of Identification
?/persOnaIlY known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
Form of Identification
~rsonallY known (Principal)
caS UII '" Ie I'"
Signature of Pu lic 0
Notarization of Lob y
Me;.. }ol )./_.(", l~.:
State of Refiea, County of Miami Dcme
Sworn and subscribed before me
This J.!J.Lday of ::;-q H ~--1' , 20 Of
4!e; Q 6~~/?
Signature of Public Notary - State of A6rida ~ "" f~,.
Notarization of Principal's signature
F
Annual Registration fee: [ Yes [ ] No Amo n
Lobbyist Registration Form received and verified b .
F:\ClER\$AlL\MARIA-M\LObbyist\LOBBYIST fORM
M~R # ~ate Paid
Revised