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Todd Tragash/2K Clevelander, Inc.m MIAMIBEACH 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 m encourage the passage, defeat or modification of any ordinance, resolution, action or derision of any rnmmissioner; 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, derision or recommendation that foreseeably will be heard or reviewed by the rity 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 speck exdusions. Please refer to Ordinance 2004-3435. ~raQasl~ 7 o rid Q . NAME OF LOBBYIST: (last) (First) (M.I) ~T~- ~mhi ~~'~i ~rnl ~-~^n~ ~i~ .35 J ~ 1 ~. l`~inmi A~i°. l`~i (~Ip i~ . ~L 3 ~l 2 ~-- ~lyr~. co I. VLOBBYIST RETAINED BY: 2 ~ GL~v~LL~•~OE.r~ KL. ~,~~v-'i.Q,uD~ BUSINESS NAME AND ADDRESS ©Zd ~~~do.C D ~ . (Number and Street) (City) 3 ~c~.( ~ 33 i3 ~ (State) (gyp Code) TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust • 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: la2c~1 c'R.-rC.T'~LI3.,~y l MP/~-o ~/~u.~u~B-i~5 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 e" -5~-dr~~ ~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHERx A) LOBBYIST DISCLOSURE: (Required) ~"~ O G /L[_, ~ B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ` ' 7 The following information must be answered: 2 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": ^ Yes ~ No• Are you lobbvina on a present or cendina bid for goods eauiument or services or on a Dresent or Dendina award for goods, eauioment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": DYes ~ No• Are you Iobbyirlg on a cendina aoDlication for a Development Agreement with the Citv or ~~ application for chance of zoning man designation or change to the Citv's Future Land Use Mau? 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 deck as required by this section but, shall not be required to pay any registration fees.. ^ Yes ~No: Are. you re~resentina a not-fgr-nrafit col•poration or entity witlwut suecial camcensation oX feimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1~ 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 EXPE~T~RES OR COMP SATION DURING THE REPORTING PERIOD. / _ I ~•7 ~ II of I do solemnly swear that all of the foregoing facts alt~i`I-ue and corr d t t I have read or am familiar with the provisions fined in io 2-482 of the Miami Bea City ode and all reporting requirements. ~ /f Signature of Lobbyist: ~~j Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification ~f Personally known (Lobbyist) ^ Produced ID Form of Identification ^ Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade Swom to an subscribed before me Sworn and subscribed before me This day of A18/' ,iii 2 f , 20_ ~ Notary PuW1c State of Florida ' 'a,,,,~ ~ ~ ~ William Pinkus • My Commission ~~i1D,,-,7p g5p Signature of Public Notary -State of M1~' Expires 10/03/201'1~r1~1:UPe of blic Notary -State of Florida Notarization of Lobbyist's signet f Principal's signature Annual Registration fee: ~',/] Yes [ ] No Lobbyist Registration Form received and verified Y