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Alexander Tachmes/Felix Acostam IV,,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 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 bond 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. Tachmes Alexander I. NAME OF LOBBYIST: (Last) (First) (M.I.) Shutts & Bowen LLP 201 South Biscayne Blvd. Miami Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) TELEPHONE NUMBER: (305) 347-7341 FAX NUMBER: (305) 347-7754 EMAIL: atachmes@shutts.com LOBBYIST RETAINED BY: NAME OF PRINCIPAL/CLIENT: Felix Acosta, President of Acosta Tractors, Inc BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) Acosta Tractors, Inc. 11986 NW 97"' Avenue Hialeah Florida 33018 TELEPHONE NUMBER: (305) 556-0473 FAX NUMBER: (305) 556-8268 EMAIL: felix@acostatractors.com Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Felix Acosta, President • IDENTIFY ALL PERSONS HOLDING, DIRECTLY CR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Felix Acosta - 100% II. SPECIFIC LOBBY ISSUE: .~~ Issue to be lobbied (Describe in detail): Invitation to Bid No. 13-07/08 South Pointe Phase 11 Right of Way Infrastructure Improvements Project, Neighborhood 12C III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(8) include a statement of the extent of any business, financial, familial, professional or other relationship, giving rise 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) An Financial, Familial or Professional Relationshi Mayor/Commissioners None City Administration Cit Attorne 's Office None City Boards Cit Committees None IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) ~ y s-~. oy ~ ~.a.~- B) PRINCIPAL'S DISCLOSURE (OF LOBB ISTy COMPENSATION): (Required). 4i yS O - O O R'~ ~'`-a-~'``-- 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 lobbvina on a present or pending 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 17J No: Are you lobbying on a pending application for a Development Agreement with the City or application for chance of zoning map designation or chance 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 LYE. No: Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: I do solemnly swear that all of the fore oing facts are 1 provisions contained in Section 2-4 the iami ad Signature of Lobbyist: _ Signature of Principal/CliaLft: -f-~ ~~~-L Felix Acosta, President VI. LOBBYIST IDENTIFICATION: ^ Produced ID NOTARY P ~,,,,".,,,•, Linda C~hristlan n PersDiP8om~lsaDibib~'i$~651416 ~••,,,,,,..,•~ Expires: MMAAKK 113, 2oli VII. SICK'01713601'R~A1V~19V1~~'~"I~TARY: State of Florida, County of Miami-Dade Sworn to and subsc ibed before me This ~ day of , 2008 ~~ r S~ SigpfatGre of Public Notary -State of Florida otarization of Lobbyist's signature Signature of Lobbyist and correct and that I have read or am familiar with the f~C~de and all reporting requirements. sta Tractors, Inc. PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification NOTARY PUBLIC - STATE OF FLORIDA [Personally known (Princip~1')••.,; Linda Christian • -Commission #DD651416 '-•,,,,,,,,.,'' Expires: MAR. 23, 2011 State of Florida, County of Miar~-~°ATT'""~ncsoNnuvcco.,txc. Sworn to and subscr' ed before me This ~ day of , 2008. ~S q..t~---' Si ture of Public Notary -State of Florida Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S USE ONLY Annual Registration fee: [ ]Yes [ ] No Amount Paid $ MCR # $ Date Paid Lobbyist Registration Form received and verified by: F:ICLER\LOBBYIS11Lobbyist Registration Form 32708.doc Revised 03/27/2008 ON OCTOBER 15t OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH LISTING LOBBYING EXPENDITURES AS WELL AS COMPENSATION m MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, vvww.miamibeachfl.gov CITY CLERK office Tel: 305.673.7411, Fax: 305.673.7254 CityClerk .miamibeachfl.gov LOBBYIST NAME: Alexander I. Tachmes I understand that no later than October 75~ of each vear, 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 for lobbyist withdrawal in writing. gnature: July 15, 2008 Date: