Brett C. Mitchell/Frank Russo- Global Spectrum
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 or 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
spe~cally includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please
rater to Ordinance 2004-3435.
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NAME OF LOBBYIST: (Last) (First) (M.I)
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AND ADDRESS (Number and Street) (City)
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TELEPHONE NUMBER:
t. LOBBYIST RDDETAINED BY:
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NAME OF PRINCIPAUCLIENT:
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BUSINESS NAME A D ADDRESS
(Number and Street) (City)
(State) (Zip Code)
TELEPHONE NUMBER: ~O 6~? a~3 ~ FAX NUMBER: (Optional) EMAIL: (Optional)
out this section if principal is a Corporation, Partnership or Trust
• 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:
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to be lobbied (De
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~Il. 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
~` u- ' ppearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Sectitm 2-
~ Z(ax4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding :,the
r ` »: ommencement of service of City personnel to be lobbied.) '~ 4 `
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' Full Name of Individual Title B) An Financial, Familial or Professional Relationship
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(Zip Code)
EMAIL:
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). rJ //k,
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 288 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
resent or oendina award for goods eauioment or services ~' ~`~ ""'" yr vn a
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
`• ~~ .~ r ccmCn[ wlin ine to i
application for change of zoning maa designation or change to the Citv's Future Land Use
Maps
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. .
1/. SIGNATURE UNDER OATH:
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Sig ature 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:
1. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
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~ c ~ ~ ~ Produced ID ~ bl, ~("il -~~ 4 ~ ~ „ Produced ID C~~~n• ~~ l5 /~5 ~~~ ~ a ~g
g Form of Identification Form of Identification
S~ ~ ^ Personally known (Lobbyist) ^ Personally known (Principal) ~ e
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II. SIGNATURE AND STAMP OF NOTARY: ~ ~~
~' State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade oy~~~~`
"~~ "'' Sworn to and subscribed before me _, _
=~'~ ~'~? his da of Sworn and subscrib before me ;;
_~ is ~_ y __~t, 2008 This '~ day of 2008 =~~~:
Signature of Public Nota -State of Florida Signature of Public Nota
Notarization of Lobbyist's si nature ry -Sate of Florida
g Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [Yes [ ] No Amount Paid S 6v - MC Z Date Paid U
Lobbyist Registration Form received and verified by: ~
F:\CLER\NATL\Form, ,tabby -a F.<~g:-;,.-.,:,:,,: c<,;-.,;.ar:•:
Revised 03/27/2008
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City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miami6eochfl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fox: 305.673.7254
CityClerk@miamibeachfl.gov
LOBBYIST NAME: ~'£~C , ,~/~ ~,~~.
I understand that no later than October 1st of each yeor, 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:
11:~visacl 02_; 04 i 2005
8,?.0 8
Date:
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