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Michelle Plowey/The Ronald W. Shane CenterMicrosoft Word -LOBBYIST fORM new logo OS.doc Page 2 of 4 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 in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 20043435. NAME OF LOBBYIST: (Last) (First) P~ow~ey ~~~,h e/le (M.I) BUSINESS NAME AND ADDRESS (Number and Street) (City (State) (Zip Code) fiS'DO ? d~ ~n Cie~~ ~ ~ jNUMBER: FAX ~ NUMBER: EMAIL: / TELEPHONE 3t7$~'~!/I ~~~ c.~Or-~-G(-' ~'a•'N/ /y11c..CallG~.r~J4hL°. C E~J ~i+, G ~Jr~ 1. LOBBYIST RETAINED BY: NAME OF PRINCIPAL/CLIENT: BUSINESS NAME AND ADDRESS (Number and Stre ,/ ~~~G /~~~~ fN ~ p7t° ( 6'^^2 j~ ^ (City) (State) (Zip Code) ~ ~ ,dew , r-~. 33.yi NUMBER: FAX NUMBER: (Optional) EMAIL: TELEPHONE 3or-~1/'~-~''~~ 3vC'-~i -/if~j ~'j~~c.~,//c @ J'l'.I?~ie c~,.~, ~as~s.~ Fill out this secfion if principal is a Corporafion, Partnership or Trust [Section 2-452 (c)J ? NAME OF CHIEF~OFQFICE~R, PARTNER, O,R/BENEFICIARY: ? IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5 % OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Il. SPECIFIC LOBBY ISSUE: VCS G'.~r~ Issue to be lobbied (Describe in detail): II[. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: http://search.blossom. com/geturl?&o=3 p&i416&KEY=lobbyist+form&URL=http://www.m... 9/4/2007 Microsoft Word -LOBBYIST fORM new logo OS.doc Page 3 of 4 N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER FLAT RATE OR OTHER) A) LOBBYIST DISCLOSURE: (Required) V B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). O The following information must be answered: I) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": Yes~o: rare you lobbying on a present or pending bid for goods, equipment or services, or on a ~`J present or pending award for goods, equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": Ye No: re you lobbying on a pending application for a Development Agreement with the City or application for change of zoning map designation or change to the City'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 anot-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.. Yes No: Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1 sT 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 RING THE REPORTING PERIOD. - f Sig afore 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~c-o~nta/in~ed in Section 2-482 of the Miami City de and all reporting requirements. i'~ X~-l~l i1 /I /I ~1 Signature of Lobbyist __~ Signature of Principal/Client: ~6~[~_ W~~ ~ CJ VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID Form of Identification Personally known (Lobbyist) Form of Identific Personally known (Principal) http://search.blossom.com/geturl?&o=3p&i416&KEY=lobbyist+form&URL=http://www.m... 9/4/2007 Microsoft Word -LOBBYIST fORM new logo OS.doc NOTARY pUguC.STATE OF FLORIDA page 4 of 4 C STA'S'E OF FLORIDA Elaine Roden NOT~tY PIJBU ~ .Commission #DD378278 Elaine Roden ~xpir~s: DEC. 09, 2008 Bonded Th*u A~and° 8endlnt Co'{ teta~ - Commission C D09 78278 Expirzs: ~- ~ S"~~TURE AND STAMP OF NOTARY: BondedThru Atlantic Boadinq Co., tnc. State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade Sworn to and subscribed before me Sworn and subscribed before me This day of ~_, 20~ This day of , 20Q 7 Signature of Public Notary ?State of Florida Signature of Public Notary ?State of Flon Notarization of Lobbyist's signature Notarization of Principal's signature ~p ~ (~y~(~'('~?p~~R CLERK'S USE O/N'~L Annual Registration fee. ]Yes [ ] No Amount Paid VW ~ r' MCK # ~ ~. ~~ Date Paid C1 Lobbyist Registration Form received and verified by: F:\CLER\$ALL\MARIA-M\ Lobbyist\ LOBBYIST t1DRM o http://search.blossom. com/geturl?&o=3 p&i416&KEY=lobbyist+form&URL=http://www.m... 9/4/2007