Juan Carlos Bermudez/George Green - Johnson Controls, Inc.m '',r,,!:'~BeACH
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
I. LOBBYIST RETAINEJa BY:~
// O ~'
ENT: % ~ l%
(Zip Code)
E NUMBER: FAX NUMBER: (Optional)
d~
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
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:
A Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
.,
I
i
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
III. 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.)
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER): ~
A) LOBBYIST DISCLOSUFj,E;i(RequirQd) r"~ `~' W
cczz''~~:.ice ~~~i God. w ~_~_
B) PRINCIPAL'S I
(Required).
OBBYIST COMPENSATION):
a
The following informati6n must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
~i'y n Aln• ern vn~~ Inhhvinn nn a nracPnt or nPndina bid for goods equipment or services or on a
present 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 lobbying on a pending application for a Development Agreement with the City 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 ~o~ Are you representing snot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of Principal/C
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
~^Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to anti subscribed~eforq rye
TO BE COMPLETED BY CITY
Annual Registration fee: ( ]Yes [ ] No Amount Pa'df $ '
Lobbyist Registration Form received and verified by~~_
PRINCIPAL IDENTIFICATION:
~ Produced ID
Form of Identification
i~'Personally known (Principal)
State of Florida, County of Miami-,p-r~..,-.e,
Sworn and subscrib d befor me'i oj'~~ nue, tJotary Public State of Florida
This ay of ,y2~08T Sh~;lly Crespa
~~: -..; ~dy Commsssion DD537182
~ 4 Expires 04105/2010
Signa Public Notar - to of lorida T ~~~'
Notarization of Principal's signature
STAFF ONLY
MCR # Date Paid
Revised
Si lure of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the
provisions contained in Section 2-482 of the Miami Beach City Code and all reporting requirements.
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CiryClerk@miamibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: yy~~ Cf1'~L°J ~~/L,~r~•/n~sL
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.
y ~`k!n y
Signatur Date:
F:TCLERILGBB~'iS"rtLobt~yist Registrakion Form 32708.doc
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 Sal Bonus
Alfredo L. Gonzalez $325 er hour
Trac Walker $285 er hour
Juan Carlos Bermudez $325 er hour
~I~I~I~J
M IAM I BEACH
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.pov
We are committed to providing excellent public service and safety to al! who live, work and play in our vibrant, tropical, historic community.
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