Gerald Schwartz/Baylights Dev. Co/Kim Rodsteinm 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 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 engaged
in lobbying activities. The term "Lobbyists° has specific exclusions. Please r"efe~r tonOrdinance 20043435.
NAME OF LOBBYIST: (last)
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BUSINESS NAME AND A DRESS (Number and Street) (City) (State) (Zip Code)
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TELEPHONE NUMBER:
FAX NUMBER:
MAIL: ~
I. LOBBYIST RETAINED BY:
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NAME OF PRIN IPAL/ ENT:
BUSINE S NA E AND ADDRESS Number and Street) (City) (State) (Zp Code)
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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: K~ ~ ~ DC~ ST °~ ~ f~(~
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
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A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf ~ ,~j
A) LOBBYIST DISCLOSURE: (Required) ~ ~ ~ ~ ~ ! 7
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
The following information must be. answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
_^ Yes 7BINo: Are you lobbying on a present or pending bid for goods, eauipment or services. or on a
present or pending award for goods, eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
application for change of zoning map designation or change to the City's Future Land 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 snot-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..
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
SHALL/BE~FILED EVEN IF THERE HAVEABEEN NO~E~IpENDITURES OR,iCO~~}TION DtJ~NG THE
REPORTING PERIOD. ~ ~~ ..ice" // ~~
S~'iature of Lobby'
I do solemnly swear that all of the fore ing facts are true and correct and that I have read or am
faq iliar with the provisions contai Section 2-482 of~he Nom' n~Beach Cii~ode and all reporting
re uirements. ~-~/
Signature of Lobbyist:
Signature of Principal/CliehE:
VI. LOBBYIST IDENTIFICATION:
Produced ID
of Identification
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~'`~ EXPIRES: Jflnuary 17, 2011
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MP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to an,~l subscribed efore me l'
T 's /~ -day ofd' 20 OX
,/ R MARIA
9lgnature of Public Notary -State of Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
^ Produced ID .~., ~~
Form of Iden MY COMMISSION N DD 589443
personally known (Principa ~,, f~ R' ExPIRES:~Au28~2e010
'F„p' S~'~ BorMedTMu
State of Florida, County of Miami-Dade
Sworn a d subscri before me
This [day o '"tea 20a ~
HANNAU ~-_ ~_-. _ fc'e.beeck
Signatur of Public otary -State of Florida
Notarization of Principal's signature
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P
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FOR CLERK'S E ONLY C~
Annual Registration fee: [ ]Yes [ ] No Amount Paid ` ~ ~ MCR # ~ ( ~ ~ Date Paid ~ `
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc J~ Revised 12/08/04