Bruce R. Orosz/Bruce R. Orosz, The Polo Life~ v ali '~
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, derision, recommendation of the
City Manager or any dty board or committee; or any action, derision or recommendation of any city personnel during the time period
of the entire decison-making process on such adios, decision or recortrnendation that foreseesby will be heard or reviewed by the
city commission, or a city board or committee. The term sperificaly indudes the principal as well as ar-y empbyee engaEed it
lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004435.
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NAME OF LOBBYIST: (Last) (First) (M.I)
~~ Poo ~-i~e c-L~ t ~~~{r~dJ;c.,~ ~Y. G'~ ~ . ~~ I' - ~- i_3 t
BUSINESS NAME AND A DRESS (Number aril Street) (City) (Sta (Zip Code)
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I. LOBBYIST RETAINED BY:
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N E OF PRINCIPAUCLIENT:
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
TGI CDYA\IC IJI IIInCD• COY LII I~IQCO• in.w:....~n Gu u • ~A.d:......n
~ut this section if principal is a Corporation, Partnership or Trust [Scction 2482 (c)j
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: /~ /
to
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of IndividualtTdle
B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHEf~:
A) LOBBYIST DISCLOSURE: (Required) ~ i
~.uc,
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): .U f~ , U e ,
(Required). ~j ~f V
The tolbwfng iMormatlon must be answered:
1) Pursuant to Miami Beach City Code Section 2488 Entitled "Prohibited Campaign Contributions By Lobbyists
Own Procurement Issues":
^ Yes Q"No: Are v~ou lobbvlna on a present or aendina bid 1'or goods. saulument or services. or on a present
or rrendlnc award for roods, eouloment or service?
2) Pursuant 1b Miami Beach City Code 2-490 Entit~d °Prohibited Campaign Contributions By Lobbyists On
Real Esthte Development Issues":
Ma°?
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 represerriative 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
sey~on but, shall not be required to pay any registration fees.
reimbursement .
V. SKiNATURE UNDER OATH:
ON OCTOBER 1sT OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, U8TING LOBBYING EXPENDITURES, A3 WELL A8 COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A~S~TEMENT SHALL
IBf&,FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR ~JMPENSATION DARING THE REPORTING
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VI.
ir~ly swear that all of the foregoing
~ontained in Section 2-482 of
~ of Lobbyist:
3 of PrincipaUClient
LOBBYIST IDENTIF ON:
J Produced ID
`, Form of Identification
~ Personally known (Lobbyist)
VIL 3KsNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-0ade
Sworn ip and subscribed fo me
This day of U~ ~~f 20 ~
rg afore of Public Notary - S~Ite of Florida
o zation of Lobbyist's signature
are
try6 and co and t I ha read or am familiar 1Se~NC~p ~~i~~i
~
Sea h~ity Co and all repo 9 requirements. ~~5; • ~gS10N~p•.•
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PRINCIPAL IDENTIFICATION: N
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J Produced ID ~~/lf~~llllll \! ~
Form of Identification
'Personally krwwn (Prindpal)
State of Florida, County of Miami-0ade
Sworn and subscri re me
This t~- day of ~~ ~~/, 20 ~
p furs of Publ~ Notary - Sta of Florida
o rizatbn of Prlndpal's sl afore
TO BE COMPLE/TED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes [/] No Amount Paid $ ~- ~v ~~ O
MCR # Date Paid ~
Lobbyist Registration Form received and verified by: _ _ ~~~;_=
Revised 02/04/2008
City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, vrww.miamibeachfl.gov
CITY CLERK Ctffice CityClerk@miamibeachN.gov
Tel: 305.673.7411 ,fax: 305.673.7254
LOBBYIST NAME: ~ ~ ~ ~ P '~ . V SUS L
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
C>ffice 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 Couniy 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.
i(~-LZ-D~
Date:
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