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Albert Wasson/Live Nation Worldwide, Inc.m MIAMIBEACH City of Miami Beach Office. of the City Clerk 1700 Convention Center Drive, Miami Beach, i=L 33139 ~~ ~- ~_ LOBBYIST REGISTRATION FORM ~ -n Lobbyist means all persons employed or retained, whether paid or not, by a prindpal who seeks to encourage the passage, def~j or modifiption of any ordinance, resolution, action or derision of any commissioner; any action, derision, recommendation of ~ Gty Manager or any dty board or committee; or any action, derision 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 city commission, or a rity board or committee. The term sperifically indudes the prinripal as well as any employee engaged in lobbying activities. The term "Lobbyists" has spedfic exclusions. Please refer to Ordinance 2004-3435. Wasson Albert J. NAME OF LOBBYIST: (Last) (First) (M.I) Live Nation 500 E. Broward Blvd., Fort Lauderdale, FL 33394 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 954-626-7878 954-626-7886 ajwasson@livenation.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Live Nation Worldwide, Inc. NAME OF PRINCIPAL/CLIENT: 934$ Civic Center Drive Beverely Hills CA 90210 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code) 310-867-7000 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) ''~ -~, A ~~ ,a• ~ l 1 W Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)I • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Michael R~ino, 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): IIL CITY AGENCIE5/INDMDUALS TO BE LOBBIED: A) Full Name of Individual/Title e) Any Financial, Familial or Professional Relationship Tim Hemstreet/Assistant City None Manager; Anyone else who will be overseeing the agreement between Live Nation and the City. 4 Q ]V. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTNERj __ n „ A) LOBBYIST DISCLOSURE: (Required) .~; /r ~ -" 1 e B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required) The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 F~titled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": ~ Yes ^ No Are you lobbvina on a cresent or uendina bid for goods eauioment or services, or on a ore~ent or oendin.^. ward 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 b5 No Are you lobbvina on a ndina application for a Develonm~nt Agreement with the City or lication for chance of na map des~anabon or chance to the Crtv's Future Land Use ~~ 3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of "lobbyist" as s~~ 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 rorooration or entity withoL~* special compensation or reimbursemerrt. . Y. SIGNATURE UNDER OATH: ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING ENDITUR S, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR TH P CEDI CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO ITM OR COMPENSATION DURING THE REPORTING PERIOD. IJ ~ of Lobbyist ~ o p N y OJ ~~~m to ~ ~ E ~~~~ c~~$ ~~ipr I do solemnly swear that familiar with the provisior requirements. Signature of Lobbyist: going facts are true ai't~ correct and that I have read or am Section 2-482 of the Miami Beach City Code and all reporting Signature of Principal/Client: VI. LOBBYIST IDE~jNT11FIpCA1T'ION: ~,~( ~roduced ID t (~ VK-~V~~ L((,#--/, VSt" Form of Identification ^ Personalty known (Principal) p Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Swom to and subscribed befor a ~7 This d day 20 ~. / Signature of Public Notary -State of Florida Notarization of Lobbyists signature PRINCIPAL IDENTIFICATION: ^ Produced i~7 Form of Identification 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 ~c 0 Annual Registration fee: [ )Yes [ ) No Amount Pai O ' `~ MCR / ~ Date Paid ~ ~ Lobbyist Registration Form received and verified by: F:\CLER\~ALL\MARIA-M\LObbyist\LOBBYIST fORM 05.doc Revised 12/08/04