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Andrew Hertz/The Orange Bowl CommitteeAUC~-24-2887 04:44P FROM: ~ MIAMIBEACH T0:3~5341475~ P.c-3 City of Miami Beach C+ffice 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 nat, by a prindpat who seeks to encourage the passage, defeat or modiftcatlon of any ordinance, resolution, actl0n or derision of any commissioner; any ad9on, derision, recommendation of the City Manager or any dty board or committee; or any action, derision or recommendation of any rity personnel during the time period of ttte entire decision-making process on such anion, derision or remmmendation that foreseeabty will be heard or reviewed by the dty commission, or a dty board or committee. The term spedftplly Indudes the principal as well as any employee engaged In lobbying actfvlges_ The tenor "Lobbylsb" has speclflc exclusions. Please refer to Ordinance 2D04-3435. L /~,~,~ P NAME OF LOBBYIST: (Last) (First) (M.i) M~~Mi SeuY~''~iJV'1 n ~'y0D R'pl~~Q~yLLr/...cf ~'y,.,~~ ~'v,.t.! F' 33/`/~ BUSINESS NAME AND ADDRESS (Number and Street) (City) ~ (State) (Zip Code) ~r,~ 36~ z~'33 ~~~; 36 1607'7 Meg~,~e~i~(~ I"~Sc~ . TELEPHONE NUMBER: FAX NUMBER: EMAIL: Y. LOBBYIST/I RETAINEQ BY: /n~ ThC ~rc..n(1e_ /JJaJI Cr~,~+.~r ~eP NAME OF PRINCIPALJCLIENT: NAME AND ADDRESS (Numt-er and Street) (City) (State) (Z!p Code) FAX NUMBER: (Optional) EMAIL; (Optional) FIII out this section If pMnclpal is a Corporation, Partnership or Trust [section 2.482 • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 59b OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOB6Y ISSUE: Issue to be IIL CITY AGENCIES/INiDIVIDl1ALS TO BE LOBBIED: r`e w A) Full Name of Indlvldual/Title B) Any Financial, Familial or Professional Relationship N~ ~ ~~,~ ~ ~~r~ 1, HUG-24-2007 ~4:44P FROM: TO :3053414750 P ... rt' IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOL/RLY, FLAT RA7E OR OTHERf. . A) LOBBYIS"f OISCLOSURE: (Raqulrod) B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): The following 1nMnt~ation must be answered: i) Pursuant to Miam1 Beach Clty Code Section 2-486 Entitled "Prohibited Campaign Contributions By Lobbyists 11;~Y 3) Pursuant to Mlaml 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 anot-for-profit corporation or entity without spectai oampensation or reimbursement Por the appearance, whether direct, or Indir+eet, to express support of or opposition to any item, shall register with the cleric as required by this section but, shall not be required to pay any registration fees.. V. SIGNATURE UNDER OATH: ON OCTOBER i~ OF EACH YEAR, EACH LOBBYIST SHALL 5UBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, Li5TING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THIE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FitLED EVEN IF THERE HAVE BEEN NO EXPE ITURES OR PEN5ATiON DURING THE REPORTING PERIOD. Signature of 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 oontalned In Sectbn 2-482 of the Miami Beach City Code and all reporting regulrements. Signature of Lobbyist: Signature of Principal/Gien~_~, VI. LOBBYIST IDENTIFICATION: n Produced ID Form of Identification r ,a ~ ~ Personally known (Lobbyist) 8 SIGNATURE AND STAMP OP NOTARY: i fate of Ftarida, County of Miami-Dade worn nd subscrib before e s ~_ y ^of ,, 20 ~~ Ignature of Public Notary -State of Florida otarizatlon of Lobbyist's signaturo PRINCIPAL IDENTI ICATION: duoed ID ~ " Form of Identification ®.~...r~+o _ U Personally ,f YHERNANDEZ :*. ~' '~~ISSION # DD 626313 ~;., EXPIRES: May 3, 2011 ^~ Ar~,~dio' Bonded Ttru Notary P~IIc UrdeiwrAers State of Florida, County of Miami-Dade Sworn anal subscrl befo me ~r This ~~`~' day~f ~ 20~ D Signature bf Publit~l - for Notarl:atlon of R~Incipal's slgnaturo KJK C V vna.r O Mlnnual Re9lstratlon fee: ( ]Yes [ No Amou Id ~ MCR aid Lobbyist Registration Form received and verlfted by: Re sed 12 08/0 F:\CLER\$ALL\MARL1-M\Labbylst\LOBBYIST FORM 0 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real AUC-c4-~07 04:44P FRAM: 70:3©53414750 p,:~~3 3V. t?ISCLDSI)Rle CFTEANSAND AMpUN75 OF LDBSYISTCOMPENSATIDN (DISCt.OSa; WHETHER l5/DURLY, fLATKATE'OR OTHFAf A} L088YIST bISCLOSURE: (Iiequlrod) S) PRIHQPALS DCSCLOSLIRE (OF LOBBYIST COMPENSATION): T3~e fial[awing inlbnmatton must be snswennd: 1} Pursuant to Mfami Beach Qty Code Secxlon 2-488 Entitled "Prohibited Campaign Contributions By Lobbyis`~s On Procurement Issues"; z> ~~ 3) Pursuant rA MfamE Beach CJty Code 2-484 (h) Any person {except those exempt tram the definltton of "IabbyLst" as set Earth In Section 2-481 above) who only appears as a representative of snot-for-proftt corpora ion or er],tlLy in+!lhout spec[ai compensattan or reimbursement for the appearance, whether dfred, or ~litdirt~ to express support of or apposition to any Item, shah register wait the dark as regsired by this section but, shall not be required to pay any regls>radan fees.. V. SI6AlATURF tlNpEti OATH: ON OCTOBER i~ QF FACH YEAR, EACI~t Lp68YIST StiAU. SUgh~I7 TO THE CITY CLERK A SIGNED STATEMENT [iNDER OATH, l.1STYNG t066YIlVG EXPE>4DITURES, AS 'WELL AS COMPENSATION REC>c31fED, IN THE C17Y OF M3AMI BEACH FOR THE PRECirDINQ CALfNDAit YEAR. A STATI:IMENT SHALL t3E FILED EV£N IF THER£ FtANL BEEi~I NO E7tPE1ypITtJiLES OR PENS,iTION DURING THE REPOR-RNG PERIOD, - /1 Ii j"` 'V'Slgnatsue of L,ob#ryfst I do solemnly swear that all of tl,e Foregoing faces are true and correct and that I have read or am familiar with the provisions cantafned fn 5 482 of the Miami Beach City Code and all reporting requin~nents. ~ . , Signature of Lobbyist: $ignat sre Df Principai~iDlen ^ 'v_ i /' VI. LOIit3YLST IDENTIFiCATIDN; n Produced Ia Form of IdentJfiratlan ~ ~~• ~ Personally known (t.n6bylat) 8~ • SIt=NAT1JRE AND STAMP at= NOTARY: fate of Florida, County of Mfami-Dade wam tq end subscrlb' before e ~~ '(, 6~2~ ~LfiGO Ignatun: of PubBc Notary -State of Florida tarizatlon of Lobbyist's algnatstro Pursuant to Mlaml Beach City Code 2-49Q Entftfed "Prohlbft8d Campaign ConMbuttnns By Lobbyists On Reaf estate Development Issues": . pRIMC=PILL IOfN CJ~TION: Form of Identlficattan ^ Personally "~~,'.., Y HERiuaNO¢ =,; ~~ ~1YISSi0NkDQ626373 ~. P= ~ EXPIRES: May 3, 2011 ~~!lr.~Pt~c Baded7MiNM.ryP+l~Beuneanrrlbis State of Florida, [aunty of Miami-Dade Swom and suhscrl halo me r~ Thls~_day~f 2DJZ ! S-gnature 6f Pubfla,,'iVirtary•-5tate~£-Florida Notarisatlan of Prlndpal's signature ~4nrwa) RegLs~-atlon fee: [ ] ye9 [ ~! IVO AmnOua Id ~ U ONMCR ~ a1d b ~ Lobbyist RegLse-ation Form received and verified by: F:1C7fR~;ALL\IMARIA-M~LobbylSt~LL?BBYIST fORM a i2e sad 1Z 08/04