Steven Sonenreich/Mount Sinai Medical Center'~-~
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,
recommendaton of the City Manager or any city board or committee; or any action, decision or recommendation of any
city personnel defined in any manner in this section, 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.
Sonenreich Steven D
NAME OF LOBBYIST: (Last) (First) (M.I)
Mount Sinai Medical Center 4300 Alton Road Miami Beach FL 33140
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 674-2520 (305) 674-2007 sdsCalmsmc com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Mount Sinai Medical Center
NAME OF PRINCIPAL/CLIENT:
4300 Alton Road Miami Beach FL 33140
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 674-2121
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:
Mount Sinai -Miami Heart Institute matter
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional
Relationship
1. Planning Board None.
2. City Commission
3. City staff
4. Health Facilities Authority
5. Zoning Board of Adjustment
6. Health Facilities Advisory Board
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
~o~
~m~~
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~$~
A) LOBBYIST DISCLOSURE: (Required) $ 0
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 0
X Yes ^ No Are you representing a not for-profit corporation or entity without special compensation or
rgl'mbursement Pursuant to Ordin~t ce No 2004-3435
1) Pursuant to Ordinance No 2003-3393 Amending Miami Bch City Code Chanter 2 Article VII Division 5
Thgreof Entitled "Campaign Finance Reform" Via The A~lition~f Code Section 2-488 Entitled "Prohibited
Campaign Contributions By Lobbyists On Procurement Issues":
^ Yes X No Are you lobbying on a present or cending bid for goods equipment or services or on a present
or pending award for goods equipment or service?
2) Pursuant to Ordinance No 2003-3395 Amending Miami Beach Cilv Code Chapter 2 Article VII Division 5
thereof En>itled "Cam airman Finance Reform" Via The Addition Of Code Section 2-490 Entitled "Prohibited
Campaign Contributions By Lobbyists On Real Estate Development Issues":
^Yes X No Are you lobbying on a cending application for a Development Agreement with the Citv or
application fir change of zoning map designation or change to the City's Future Land Use Map?
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 COMPENSATION QjJ~IN~ THE REPORTING PERIOD.
SignatureJof 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
reporting requirements.
Signature of Lobbyist: ~~
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPi
^ Produced ID
Form of Identification
~rsonally known (Lobbyist)
2-482 of the Miami Beach City Code and all
IDENTIFICATION:
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to~nd subscribed b fore me
This 1 day of 20~~/
Signature of Public Notary -State of Florida
^ Produced ID '"~'
Form of Identification
„o,
~onally known (Principal) ~
~~~
State of Florida, County of Miami-Dade ~ °z ~
Sworn a~subscri ed efore me ~ v
This day of 21~ti o
~"
ignature of Public Notary -State of Florida
Notarization of Lobb fist's si nature Notarization of Princi al's si nature
FOR CLERrK~S~USE ONLY
Annual Registration fee. ]Yes [ ] No Amount Paid 1 w~~~ Q-'0.Jr CM R # ~~ Date Paid
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F: CLE LL\MARIA-M\LOBB~LOBBYIST FORM 04
~ First Revision - 05-17-02