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Dean Lewis/Eric Milon m - ~ 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. Lewis Dean B. NAME OF LOBBYIST: (Last) (First) (M.!) D.B. Lewis Architecture + Design BUSINESS NAME AND ADDRESS 120 NE 27 Street Suite 500 Miami (Number and Street) (City) Florida (State) 33137 (Zip Code) (305) 572-1220 TELEPHONE NUMBER: (305) 572-9161 FAX NUMBER: dlewis@dbla1.us EMAIL: I. LOBBYIST RETAINED BY: Eric Milon NAME OF PRINCIPAL/CLIENT: 222 S. Coconut Lane BUSINESS NAME AND ADDRESS (Number and Street) Miami Beach (City) Florida (State) 33139 (Zip Code) (305) 992-0840 TELEPHONE NUMBER: 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: . IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Design Review Board and Board of Adjustment Application 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 DRB and BOA None IV. Ul;:)~LU;:)UKt: Ut I t:KM;:) ANU AMUUN I;:) Ut LU~IH 1;:) I ~UM..t:N;:)AIIUN lUl;:)~LU;:)t: wnt: I nt:K nVUKL T, FLA T RA TE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $ per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ per hour 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": D Yes X No: Are YOU lobbyina on a oresent or oendina bid for aoods, eauioment or services, or on a oresent or oendina award for aoods. eauioment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": DYes X No: Are YOU lobbyina on a oendina aoolication for a Deyelooment Aareement with the City or aoolication for chanae of zonina mao desianation or chanae to the City's Future Land Use Mao? 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.. D Yes X No: Are YOU 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 EXPENDITURES OR C P SATION DURING THE 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 S . n -482 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: -- VI. LOBBYIST IDENTIFICATION: L Produced IDC/II'lIe y/ S J/ c e J1 S e.- Form of Identification PRINCIPAL IDENTIFICATION: LJ Personally known (Lobbyist) [ Produced ID / Form of Identification ~ersOnallY known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn and subscrib~before me This 2-~, da of A~J., 20 FOR CLERK'S USE ONLY Annual Registration fee: [ ] Yes [ ] No Amount Paid \ 0'5....:.....00 MCR # .2.<<?>ca~ Lobbyist Registration Form received and verified by.: "'\ ~~ Entered By: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc '-..:J ~5:~-'~1 ~~ ,,~~;~::;;;~ t. I ~Qrjf"r~- 51 c;~ ..... . ~;xl~t:?c"?g -;...~/~.>>')~..:: 1/1'''11\\\\ is' lf~ R~Q8 ~ (03~-< ~. 1 Q. OJ =< " >f~ l,.~j: ~.: ~ ~~.. ~:.:J !i1 . :s:~ g 'i';~. ~:....,l . Q. 0 ~ 9. ",:l!l zo?"':"'; . ~-?. i3 rr So t3' ~o G>tv-n ~< t:;ts" )~ t'l ~ Q (i "i~ ;3 ~6 0 '''( Date Paid ~-6I(o /tS1- I Revised 12/08/04