Mikael J. Kaul/Replay USA>~n~~i ~~~~~
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, ad9on or decision of any commissioner; any action, decision, recommendation of the
City Manager or any city board or committee; or any action, derision or recommendation of any dty personnel during the time
period of the entire decision-making process on such action, derision or recommendation that foreseeably will be heard or reviewed
by the city commission, or a rity board or committee. The term specifically indudes the princpal as well as any employee engaged
in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 20043435.
NAME OF LOBBYIST:
~1 r ~~~`~
BUSINESS NAME AND ADDRESS
~~o~ 5~3 g~~1
TELEPHONE NUMBER:
Dumber and Street)
~~3 9g~2,
NC ~2nf~'1~ Z~~t#3v3
FAX NUMBER:
~~•~.~~
331'z~'
(Stat~e~) ~~(~ A (Zip Code)
EMAIL:
I. LOBBYIST RETAINED BY:
~~~ vs~
NAME OF PRINCIPAL/CLIENT:
NI~c~ ~~ ~~tlU~~sr 11~~~ NK. N~Y.
S NAME AND ADDRESS
zl ~'~G 3 222-
sand Street)
2! ~ G
FAX UMBE
(City)
~state~
00 ~~
(Zp Code)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
tt~a ~ i~N~..ior
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
P~ov~ DM~to '3~.33y'~ 5lLV1R ~~~~~~. 33.33% C~Ik,.rQ~oc,~ ~u2~nl, 33.33
II. SPECIFIC LOBBY ISSUE:
i~~ Fwv~ PUtti~l ~~fi[v'~
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
N ~t`c
~~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLATRATEOR OTHERt y~ ~-~i~ D a~ ,f~ r,, ,~
A) LOBBYIST DISCLOSURE: (Required) _ ~l t ~~1 ~~~~ ~ ~-`~C~~ ~~ d~1' ~~~ ~ I~~ c' ~`~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). it
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 ~IVo: Are you lobbying on a uresent or uendina bid for goods, eauiument or services. or on a
present or vending award for goods, eguipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
„„ ~~Ejjstate Development Issues":
^Yes 6l~No: Are you lobbying on a uendina application for a Development Agreement with the Citv or
application for change of zoning map designation or chance to the City's Future Land Use
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 2-181 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..
^ Yes ~o: Are you representing coot-for-profit coruoration 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 EXPEND~TTURES OR O PENSATIO 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 containgd in ection 2-482 gf~the~Miami Beacp,City Code and all reporting
reQUirements. ~ ~ ~~~ ~ 11`~ /"~ / , ( l
~ nature of Lobbyist: v U
o~~°~.
_W ~ ~ ~,
nature of Principal/Client:--
H $ LOBBYIST IDENTIFICATION:
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~roduced ID~~(--~~~~~~~~~~~~~~~>
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z E Form of Identification
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^ Personally known (Lobbyist)
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~ ~- I. SIGNATURE AND STAMP OF NOTARY:
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fate of Florida, County of Miami-Dade
^ wpm to and subscribed before me
n
is r ! day of ~'
'`L ~ 20~~~'
Sign ture of Public Notary =-State f Florida
Notarization of Lobbyist`s signature
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This day of , 20_
Signature of Public Notary -State of Florida
Notarization of Principal's signature
'' FOR CLER 'SIS U~NLY K~ f,,~ ~ ~_
Annual Registration fee: [~'~] Yes [ ] No Amount Paid / ~- MCR # ~ x J ~ Date Paid -~ 0 `
Lobbyist Registration Form received and verified by: ~'~/t ~
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc Revised 12/08/04
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IV, pIS£LA4UR£ OF TERMS ANi? AMOUNTS OF L48t3YIST COMPENSA7TON (DISCLOSE WHE'fHt:R~t/G4RL~', 1 _ ~ U1St0
F4iTRATf OR Q7HFRj, 2i Se• t'Y~ U1. V~.~
A) LOBBYIST DI5GLOSURE: (Required) ~~~T Q~~~-mod ~ $20.094 ~} ~~~
- BIA1
8} PRINCIPALS t?ISCt.OSURE (QF LOStiYISTCOMtPENSATION}: (Required). - __
The fallowing information must be answered= T'eSlC~ei
I) Pursuant to P~iami Beach City Code 5extJon z-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
Sono c~
Y a o 6 f i or a
ara~sent or eendina aw8 f fi ~~, eauinment or s rve ice? - Asolo,
2} Pursuant to Miami Beach City Cade 2.490 FJttttled "Prohibited Campaign Contributions $Y Lobbyists C+n Reaf
Estate Development Issues°, ~
~~
a
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3) Pursuant to Mlaml Beach Ciry Cade 2-484 (h) Any person {except those exempt from the de8nltton of
"lobbyist" as set Earth in Section Z-i81 above) who only appears as a rspresentatlve of a not-far-pn~it
corparatlan or entity wltixfut specyal compensation orreimbursement for the appearance, whether direct, or
indirect, to express support ~ or apposiGan to any i4om, shah register with the clerk as required by this
section but, shalt not be required to pay any registratlon fees.-
~ Yes TIHa~ Are vau rgnresentina A {IC}I'-#or-nrarn cariraranQ,R,4f ~~yyn- +erru~oas s~fecrae epmp~s~oon
ar r~bursement. .
V. SIGNATURi: UNDER QATH:
DN OCTOBIER ~~ OP EACH YiiEAti, EJ1CH lL4BBYIST SIfAU. SUBMIT TO THE CFTY CE.B{ilf A St[ONI~
Si'ATEMIENT UNDER OATH, ixST7Nfs LOBBYING i7CPE(VDiTUtItES, AS VYELL A5 COMPEN5AT10N
RI~CEMED, IN THE C,ITI' ~ MIAMI B1rAGH PQR THE PRECEDIhEG CALF.Ni)AR YtsAR. A SrATEMLNT
SHALL BE 1~#.kD E1/:EN IP TFfERE HAVE BEEN NO EXPEND URES OR P~NSA kii'tING THE
REPt1RTINt3 AE~4D.
Signature of Lobtrylst
l: do solerrlniy swear that all of tl~e foregoing facts are true and correct ai•xl that X have read ar am
familiar with the provisions c~nr>taln~d ih ~ 2-482 ~f,~liarni t3ear~Clty CAde arid alt reportMg
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LassYlsT IDENTIFYC/t3IW~2:
PRIAt~GIPAL ID~NTIt°ICATIDriis
~roduced IDi~I-'~L~~(JE?~3~f ~'i) pProduced ID
Farm of ider:tif:catlnn
a Personally known (Lobbyist)
5ICsNATURE AND STAMP OP NOTARY:
fate of Florida, County of Miarrti-Dade
wnrrt~ nd subsCri b me
s / day of 2b
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Signature of Public l4otary to Florida
Natarixat~n of Lobbyist's s~nature
Form of Identiftcadon
o Personally known (Prindpal}
State of 1=lortda, Caurity of Miami-Qade
Sworn and subscrlaed before me
This day of . 20.~
Signature of Public Notary -State of Florida
NatarizaHari of principal's signature
FpR CLE S tI~F ONLY
Armuat RegisflatEOn fee: [ j Yes [ ) Na Amount Paid ~ MCR # rx~cli?~. ~'~ ~ iJate Paid ~' o
Lobbyist Registration Form received sod verified hY:
F:ICLERISALL1t'9ARTA^4ilLobbYistlLOBi3YI5T fORM U5.Qoc .~ Revised 12/f~104
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BIANCARDI ATTILIO, nato a Castelmassa RO it iorno 5 lu lio 1944
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City of Miami Beach, 1700 Convention Center Drive, Miami Beoch, Florida 33139, `^^^'w.miamibeachfl.gov
CITY CLERK Office CiryClerk@miamibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: _ ~ ` ~` ~~Z-- ~~ \~
I understand that no later than October 1st of each v,_,_ectr, 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 tronsmitted 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.
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Signatu e: ate:
E~s:visaa oz;oa_fzoo~
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