James E. Rauh/Mike Lerner
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MIAMIBEA:CH
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 specific exclusions. Please refer to Ordinance 2004-3435.
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(City)
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(State)
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(Zip Code)
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NAME OF LOBBYIST:
(Last)
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(First)
EMAIL:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAljCLIENT:
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BUSINESS NAME AND ADDRESS
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LEPHONE NUMBER:
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(Number and Street)
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(City)
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(State)
5s/35-
(Zip Code)
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:
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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,
FLATRATEOR OTHER):
1,6-0, ,,0
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A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (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":
~o: Are yOU 10bbvinQ on a present or pendinQ bid for Qoods. equipment or services. or on a
present or pendina award for aoods. eauipment or service?
DYes
2)
Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
~o:
Are yOU lobbvina on a pendinQ application for a Development AQreement with the City or
application for chanQe of zoninQ map desianation or chanae to the City's Future Land Use
Map?
DYes
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
indirectl to express support of or opposition to any iteml shall register with the clerk as reqUired by this
s~ion butl shall not be required to pay any registration fees..
~o: Are you representina a not-for-profit corporation or entity without special compensation
or reimbursement.
DYes
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 P ING ENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO E NDITU ES R COMPENSATION DURING THE
REPORTING PERIOD.
e and correct and that I have read or am
e Miami Beach City Code and all reporting
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VI.
LOBBYIST IDENTIFI
PRINCIPAL IDENTIFICATION:
J Produced ID
J Produced ID
Form of Identification
~rSOnallY known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
yersonally known (Principal)
State of Florida, County of Mi
Sworn and subscrib e
This ~ay of
o LY {{1 7~
MCR;;z)$ if D.~te Paid
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Signature of otary
Notarization of Principa
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