Pablo Acosta/Standard Parking Corp.m 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 deasion-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 spe~cally includes the principal as well as any employee engaged
in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
Acosta, Pablo
NAME OF LOBBYIST: (Last) (First) (M.I)
131 Madeira Avenue Pentltouse Coral Gables, Fkxida 33134
BUSINESS NAMEANDADDRESS (Number and Street) (City) (State) (Zip Code)
3054448102
TELEPHONE NUMBER FAX NUMBER EMAIL:
(305) 534-2373
I. LOBBYIST RETAINED BY:
Standard Parking Corporation
NAME OF PRINCIPAL/CLIENT:
1674 Meridian Avenue 106 Miami Beach, Fbrida 33139
BUSINESS NAMEANDADDRESS (Number and Street) (City) (State) (Zip Code)
305.534.6888
TFIEPHONE NUMBER FAX NUMBER (Optional) EMAIL (Optionaq
Fill out this section if principal is a Corporation, Partnership or
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Thomas Hagerman, Chief Operating Officer
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: See attachment re: 5% Beneficial Ownership
II. SPECIFIC LOBBY ISSUE: RFP No: 11-07/08(~arking~ashiers, Attendants and Supervisors for the City of Miami
Beach Parking System r-- \
Issue to be lobbied (Describe in detail):
III. CITY AGENCIESANDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
Mayor and City Commissioners
(see attached list) None
Administration None
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IV. bISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) Flat Rate $30.000
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibihed Campaign Contributions By Lobbyists
On Procurement Issues":
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
Maa?
3) Pursuant to Miami Beach City Code 2484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of a not for-profit
corporation or entity without special compensation or reimbursement fior' the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees..
^ Yes ~NO: Are you representinst anot-for-profit corporation or entity without special compensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1sT OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE MAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD. .,
Slgfiature of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar
with the provisions contained in Section 2-48 of the Miami Beach City Code and all reporting
requirements. ~--7 /~
Signature of Lobbyist: -'r
Signature of Princpal/Client:
VI. LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
^ Prodioed ID rd.R~roduoed ID 'Q {~ '7 ~ S S 7
Form of Ident -- -°~- Fonn of Identification ~j Z ~z .S /z . /
tt~T°E ~ ~ti~' ~;~
Personally Ivtovuri (Lobbyist) ~ rC} " S~Z~JiV ~i~sonally Iviovun (Principal)
Er,'t~2C$ ~Y 09, ~: `
VII. SIGNATURE AND STAMP OF N~TARY ~ ~ hY 1 °t c°:-
~°~ ... ° "~~~ NOTARY 1?'tJB1,IC-5I,gTE OF FLORIDA
State of Florida, Courriy of MiamFD , `-, -..z of Florida, County oIMiami-Dade JOe ROSS
Swum to and subscribed before me 6i ~lnrom and s~ me Commission # DD524291
This day of '~.- ,, 2~3~:~ ~ , ~ ~ ~ ,.~ ~ ~ 2~- ay of ~~~ , 20~ empires: MAR. Ol, 2010
onded Thru Atlantic Bonding Co., Irit;
i . ~::.:~ 1,1:,1SV ;I:GL
Of Public - .
NOtary State of .~ y - re PubNc Nola State IOfKia
ry-
Notarization of Lobbyists signature ~ o~rri tion of Principal's signature
/ FOR CLE 'S U~ONLY g /~ 0 p
Annual Registration fee: [ i1 ]Yes [ ] No Amount Paid ~ f~ / C / ~ Date Paid O
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fiJRM OS.doc ~_~~~,~ Revi d 12/08/04
721752-1
Attachment
In reference to the disclosure of 5% or more ownership interest of Standard
Parking Corporation, please find below the ownership table is as of February 14,
2008.
John V. Holten and the JVH Descendents' 2007 Trust .....................51.3%
Loomis, Say/es & Co., L.P .......................................................5.57
City of Miami Beath, 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
L
LOBBYIST NAME:
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: Date:
Revised 02%04r'2008