Alexander Tachmes/Adam Mopsick
lQ
MI.AMIBEACH
RECE~VED
CITY CLERi'\'S D:=PT
City of Miami Beach Office of the City Clerk JUN 7 - ,[DOl
1700 Convention Center Drive, Miami Beach, FL 33139
By.
. LOBBYIST REGISTRATION FORM Tlr:ne
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:
(last)
Tachmes
(First)
Alexander
. (M.!.)
I.
BUSINESS NAME AND ADDRESS
Shutts & Bowen LLP
(Number and Street) (City) (State) (Zip Code)
1500 Miami Center, 201 S. Biscayne Blvd., Miami, Florida 33131
TELEPHONE NUMBER:
(305) 347-7341
FAX NUMBER:
(305) 347-7754
EMAll
atachmes@shutts.com .
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLlENT:
Adam Mopsick
BUSINESS NAME AND ADDRESS (Number and Street)
122 E. 2nd Court, Miami Beach, Florida 33139
(City)
(State)
(Zip Code)
TELEPHONE NUMBER:
(305) 216-4319
FAX NUMBER: (Optional)
(305) 675-6290
EMAIL: (Optional)
adam .mopsick@aniicondevelopment.com
Fill out this section If principal is a Corporation, Partnership or Trust [Section 2-482 (c))
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Nt A
. IDENTIFY All PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: NtA
II. SPECIFIC LOBBY ISSUE: Zoning variance application for 127 S. Hibiscus Drive
Issue to be lobbied (Describe In detail):
III. CITY AGENCIESIINDIVIDUALS TO BE LOBBIED:
A) Full Name of IndividuallTitle ',. B) Any Financial, Familial or Professional Relationship
Mayor None
Commissioners
City Administration None
City Attorney's Office
City Boards None
City Committees
MIADOCS 2148999 1
..... '"' . .
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLAT
RA TE OR OTHER):
A)' LOBBYIST DISCLOSURE: (Required) $400.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required) $400.00 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":
DYes 0' No: Are YOU 10bbvinQ on a present or pendlno bid for aoods, eaulpment or services, or on a present or pendlna
. award for Qoods, equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled .Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
DYes 0' No: Are you lobbvino on a pendlnQ application for a Development Aoreement with the City or application for
chanae of zonina map deslanation or chanae to the Citv's Future Land Use Map?
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 0' No: Are vou representlna a not-for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1st 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 COMPENSATION DURING THE REPORTI G ERIOD.
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- of the Miami' Beach City C de and all reporting requirements.
PRINCIPAL IDENTIFICATION:
Signature of Lobbyist:
Signature of Principal/Client::
VI.
Produced 10
Produced 10
Form of Identification,
Form of Identification
Personally known (Lobbyist)
Personally known (Principal)
Fa ,0UK'S ~:::t ~
NOTARY PUBLIC-STATE OF FLORIDA
~Marilyn Olga Becerra
Commission # DD518106
State of Florida, County of Miami-Da Expires: FEB. 14, 2010
Sworn to and subscribed before me Bonded Thru Atlantic Bonding Co., Inc.
This tow... day of ~ ,20()7
~,~~-b
Notarization of priRC-iJl'~Signature
(11 's
. D'~P'"~
Revised 12/08/04
. VII
SIGNATURE AND STAMP OF NOTARY:
,20_
Lobbyist Registration Fonn received and verified by:
MIADOCS 2148999 1