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Neil Jacobsen/Live Nation Worldwide, Inc.M I AN1 I B EAC H `~~.:._ ~ °~, -~.~ ~ ~ City of Miami Beach Office of the City Clerk `~~ , ~. 1700 Convention Center Drive, Miami Beach, FL 33139 ~~ ~,,,~ ~',,f, LOBBYIST REGISTRATION FORM Lobbyist means all persons employed a retained, whether paid or not, by a prinripal who seeks to enwurage the passage, defeat or modifiotion of any ordinance, resolution, action a derision of any wmmissioner; any action, derision, recommendation of the City Manager or any city board a 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 dty commission, or a city board or committee. The term spedfically includes the prindpal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 20043435. Jacobsen Neil NAME OF LOBBYIST: (Last) (First} (M.I) Li_v_e_Nation 500E Broward Boulevard, Fort Lauderdale, FL 33394 BUSINESS NAME AND ADDRESS (Number and Street) (Gty) (State) (Zip Cale} 954-626-7878 454-626-7886 niacobsen@livenation.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Live Nation Worldwide Inc NAME OF PRINCIPAL/CLIENT: 9348 Civic Center Drive Beverel Hills CA 90210 BUSINESS NAME AND ADDRESS (Hum rand Street} (City) (State) (Zp Code) 310-867-7000 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: Michael Rabino, Chief Executive Officer IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Live Nation, Inc. II. SPECIFIC LOBBY ISSUE: Future use and operation of the Jackie Gleason Theatre Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Finandal, Familial ar Professional Relationship Tim Hemstreet/Assistant City None Manager; Anyone else who will be overseeing the agreement between -~ Live Nation and the City. IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHERj. A) LOBBYIST DISCLOSURE: (Required) B) PRINCIPAL'S DISCLOSURE (OF LOBBY The following information must be answerea: 1) Pursuant to Miami Beach City Code Section 2-48B Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": ~5 Yes ^ No Are you lobbvina on a p ^* ^~ ^°^dina bid for goods eauioment or services, or on a ^~~~~^~ or pending 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": ^Yes ]~ No Are you lobbvina on a cendina application for a Development Aareeme~rt with the City or fig; il~aon for change of zoning map designation or cha^ap *^ ti,.. r.~w~s Fyture nd Use Ma°? 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.. n vp~ ~ No Are you representing anot-for-profit corporation Q compensation or reimbursement. 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 EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. ~ ` ` Si ture of Lobbyist I do solemnly swear that all familiar with the provisions cc requirements. Signature of Lobbyist: of the foregoing facts are true and correct and that I have read or am mtained in Section 2-482 of the Miami Beach City Code and all reporting Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: N ~ Produced ID ~~1+~2iVF~5~l L ~ ~ ~ ~ Form of Identification S ~ n Personally known (Lobbyist) ' VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed before me This ~~ day of . ~ T , 20t? '] ~. ...- ., Signature of Public Notary -State of Florida Notarization of Lobbyists signpature C? ©rn m~`~ (091 ~o ~' 1 ?k3~ i I PRINCIPAL IDENTIFICATION: v Produced ID Form of Identification u Personally known (Principal) State of Florida, County of Miami-Dade Sworn and subscribed before me This day of . 20_ Signature of Public Notary -State of Florida Notarization of Principal's signature / FOR CLERK'S USE ONLY ~ I ~ C ~ ~~ _ o~~ ~j Annual Registration fee: [ / J Yes [ ) No Amount Pai~ MCR ~ 1 / J Date Paid ~ / Lobbyist Registration Form received and verified by: F:\CLER\¢ALL\MARIA-M\Lobbyist\LOBBYIST FORM 05.doc Revised 12/08/04