Cole Haynes/Joseph W. Blount~ 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-ttte 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 teen "Lobbyists" has specific exclusions. Please refer to Ordnance 2004-3435.
Haynes Cole
NAME OF LOBBYIST: (Last) (First) (M.I)
Brodson Construction 167 NE 39'" Street Miami, Florida 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 576-9909 (305) 579-9902 cote@brodsonconstruction.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Joseph W. Blount
NAME OF PRINCIPAL/CLIENT:
2535 Lake Avenue Miami Beach FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Secfion 2-482
• 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:
Redevelopment of 2535 Lake Avenue
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title I B) Any Financial, Familial or Professional Relationship
Planning Dept., HPB, BOA, Planning Board, City Commission None
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N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATEOR OTHFRt
A) LOBBYIST DISCLOSURE: {Required) fi -~.d0 er hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).. fi'7~00 per hour
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 X Na• Are you labbvina on a present or pending bid for aoods, eauipment ar services, or on a
present or pending award for aoods equipment or service
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
f_lYes X No: Are ~u lobbyina on a Wending application far a Development Agreement with the City or
application far change of zoning map designation or change #o the Citv`s Future Land Use
Map?
3) Pursuant to Miami Beach City Cade 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 a not 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_
I:l Yes X No: Are you representing anot-for-profit corporation or entity without special compensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCT48ER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECENED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEE EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD. /'"" -°---•-~-_...'
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read ar am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Cade and all reporting
requirements.
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Signature of Lobbyis
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Signature of Principal/Client:
VI. LOBBYIST
Produced ID
/ Form of Identification
~ Persona8y known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sw to and subscribed me
T , rs ay of ~
Signature of Publl
Notarization of
Annual Registration fee: [ J Yes [ ] Na
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Florida Notary Assn., Inc
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FOR CLERK'S USE ONLY
Amount Paid MCR #
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lobbyist Registration Form received and verified by: Entered 8y: .1.~~ ~~
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
rLAT RATE OR OTHER}.
A) LOBBYIST DISCLOSURE: (Required) ~ ~ ~~ Der hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ / ~~.00 Der hour
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 X No• Are you lobbying 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 X No• Are you lobbving on a pending application for a Development Agreement with the City or
application for change of zoning map designation or change to the Citv's Future Land Use
Mau?
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 a not 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 X No: Are you representing anot-for-profit corporation or entity without special compensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ 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 HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD.
Signature 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.
Signature of Lobbyist:
Signature of Principal/Client: .~C~` ~
VI. LOBBYIST IDENTIFICATI
^ Produced ID
Form of Identification
^ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of , 20_
Signature of Public Notary -State of Florida
Notarization of Lobbyists signature
PRINCIPAL IDENTIFICATION: ~ Y
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Sworn and subscribed fore me r/
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Signature of Public Notary -State of Florida Z
Notarization of Principal's signature
FOR CLERK'S USE ONLY ~ y p_
Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # D e Paid
Lobbyist Registration Form received and verified by: Entered By: ~~
F:\CLER\$ALL\MARIA-M\LObbyist\LOBBYIST fORM OS.doc Revised 12/08/04
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City of Miami Beach, 1: D0 Corverlion Center Drive, Miomi Bench. Florica 33 t39. ww~« miami6~ochfl gov
CI i f CLEP,K (Jftice C:hrC_lerk~^~m:amibeachfl gov
Tel: 305.673.741 1 . Fox: 305 673.7254
~oBt~vrsr NAn~s: ~(~ ~~ nos
! understand that no later than October i st of each year, I muss File the following
forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's
Office for o!i active lobbying issues.
1 J 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 an 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:
7 29 ~&'
Date: