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Tracey Walker/George Green - Johnson Controls, Inc.m J~IAMIBEACH 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 modifcation 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 refer to Ordinance 2004-3435. Walker Tracey NAME OF LOBBYIST: (Last) (First) (M.I) Adorno & Yoss LLC 1349 W. Peachtree St., NW, Suite 1500, Atlanta, GA 30309 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (404) 347-8300 (404) 347-8395 twalker@adorno.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: George Green NAME OF PRINCIPAL/CLIENT: Johnson Controls 15901 SW 29th St., Suite 801, Miramar, FL 33027 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 954-538-7939 9 54-5'iR-79()'~ TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or • 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: Bid Protest tRFP 06-07/08 Issue to be lll. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code section 2-as2(g) include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise to an appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2- 482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the commencement of service of City personnel to be lobbied.) A Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship i ~ > ~ ~~ r ~ ~ ll/ P ~ ,~ ``/~ ' 1 G~/ ~i r v IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) Hourly Fee B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). HOUr y F 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 ^ No: Are you lobbvinq on a present or pending bid for goods, equipment or services, or on a resent 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": ^ Yes ~ No: Are you lobbvinq on a pending application for a Development Agreement with the Citv 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 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. ^ Yes ~ No: Are you representing snot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ST 7~ I do solemnly swear that all of the foregoing facts are true and corredt~and that I have read or am familiar with the provisions contained in Se on ~-' 82, of the Miami B ch City Code and all reporting requirements. C' / Signature of Lobbyist: `~ ~~ ~ r Signature of Principal/Client: t ~~ ~!~ ~~ VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification Personally known (Lobbyist) ~ Produced ID Form of Identification ~sonally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to an11 subscribed before me of f~.C~~L-~-~. 2008 State of Florida, County of Mia 'made-a 1PkY p48 ?Jotary Public State of Florida Sworn and subscrib,~d before o ~ Shelty Crespo This ~~day ~f ~-~r{,{'~, 0~ o My Commission DD537182 Notarization of Principal's signature TO BE COMPLETED BY CITY CLE 'S STAFF ONLY Annual Registration fee: [ Yes [ ] No Amount Paid $ MCR # a `f 3~ ~ Date Paid ~} Lobbyist Registration Form received and verified by: F:\CLER\LOBBYIST\Lobbyist Registration Form 32708.doc ReVlsed 03/27/2008 Page 1 of 1 Prieto, Silvia From: Hatfield, Liliam Sent: Tuesday, April 15, 2008 1:39 PM To: Parcher, Robert; Prieto, Silvia Subject: Lobbyists fee disclosure given by phone R7D Nanc Ashman Sala Bonus Geor e Green Sala Bonus Alfredo L. Gonzalez $325 er hour Trac Walker $285 er hour Juan Carlos Bermudez $325 er hour L3~~am MIAMIBEACH Liliam Hatfield, Office Associate V CITY CLERK'S OFFICE 1700 Convention Center Drive, Miami Beach, FL 33139 Tel: 305-673-7411/ Fax: 305-673-7254 / www.miamibeachfl.gov We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical, historic community. (l~/1 C/7il(1R m ;~a~Ann!gEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityClerk@miamibeachfl.gov Tel: 305.673.741 1 ,Fax: 305.673.7254 ~~ J LOBBYIST NAME: ~ e~~G%< C~~ / ~~ I understand that no later than October 1st of each year, I must file the following forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's Office for all active lobbying issues. 1) Lobbyist Expenditure Form 2) Disclosure Form Failure to file these forms on a timely basis will result in my name being transmitted to the Miami-Dade County Commission on Ethics and for code violation evaluation. In addition, once an issue I have registered to lobby on has been resolved, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. ~~~ !~ ~ ~ , -- Signature: ate: F:ICLER\LOBBYIST1Lobbyist Registration Form 32708.doc