Michael McKeon/Imperial Parking US Inc.
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City of Miami Beach Office of the City Cterk
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 M 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
specilicaly includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please
-tir+r to Ordinance 2004-3435. ,,'' tt c - -
NAME OF LOBBiY~IS (Last)
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1. LOBBYIST RETAINED BY:
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FAX NUMBER:
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(M.I)
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(Zip Code)
NAME OF PRINCIPA IENT:~ ` `
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BUSINES NAME AND A DRESS (Number and Street) ('ty) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: O tional EMAIL: (Optional)
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Filt out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
I IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
tI.SPECIF)C LOBBY ISSUE:
(
Issue to be lobbied (Describe in detaiQ:
111. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-4e2(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-
432(aH4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the
commencement of service of City personnel to bs lobbied.)
A Full Name of Individual Title B An Financial, Familial or Professional Relationship
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(Number and
Iv. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY~FLAi'-~
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 288 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
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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":
application for chance of zoning map designation or change to the Citv'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 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.
reimbursement. .
v. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
L~Produced ID ~
Form of
^ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOT.
State of Florida, County of Miami-Dade
Swom to an~f subscribed efore me
This / day _, 2008
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Signa(ure flub is Notary -State of Florida
Notarizat' n of Lobbyist's signature
A
PRINCIPAL IDENT
I
FICATION:
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Form of tdentificatio "'
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^ Personally known (Principal)
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~~,~~~o,, State of Florida, County of Miami-Dade ~
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.~..= Sworn anc~s ubscribe before me
This may of ~, 2008 ~
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TO BE COMPLETED B'
Annual Registration fee: [ Yes [ ] No Amount Paid
Lobbyist Registration Form received and verified by: _
F:\CLER\MATL\Form, ;t.obbv -* Nec >* -+..~: F~. •-~-dr•:
Signature~P`i~lic.$(QYa ~ - to of Fli
Notarizat on of Principal's si ature
LERK'S STAFF ONLY
~~MCR # Date Paid
' Signature of Lobbyis
( 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 Sectiory~-482 of the Miam~Beach City C-all reporting requirements.
ce
Tel: 305.673.741 1 ,Fox: 305.673.7254
City of Miami Beoch, 1700 Convention Center Drive, Miomi Beoch, Florida 33139, www.miamibeachfl.gov
CITY CLERK Offi
LOBBYIST NAME: ___l~-G~
CiyClerk@miam ibeachfl.gov
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I understand that no later than .October 1st of .~.~I,
forms, pursuant to Section 2-485 of the Miami Beach C tyg~Co'de,nv„ithf'the Ci fo"OW1n9
Office For all active lobbying issues. ty .Clerk's
1) Lobbyist Expenditure Form
2) Disclosure Form
Failure to file these forms on a timely basis will result in my name being transmitted
Miami-Dade County Commission on Ethics and for code violation evaluation. ~ the
In addition, once an issue I have registered to lobby on has been resolved
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing! am required
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17~visad oa_ioa~2oos
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Date.
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