Melissa R. Ross3 7 i~ ~ ~~ r.~ ~.~,,~ ~'~~-
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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 arty action, decision or recommendation of arty aiy 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 aty commission, or a city board or committee. The term
spec~cally includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please
refer to Ordinance 2004-3A35.
Ross, Melissa R
NAME OF LOBBYIST: (Last) (First) (M.I)
Ross Engineering, Inc. 3325 S. University Drive, Suite 111 Davie, FL 33328
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
954-318-0624 954-358-0190 mross@rossengineers.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
~*_ Patrick Church / Mosianor Vaughan
NAME OF PRINCIPAUCLIENT:
St. Patrick Church 3716 Garden Ave Miami Beach, FL 33140
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-531-1124 305-538-3203
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5°,6 OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
n.SPECIFIC LOBBY ISSUE: ~7!(e C~7C~sr~c1 ~f~ , ~~~~ ~~~
Site Plan Approval for Preschool Addition and Roadway Improvements for the St. Patrick church
Issue to be lobbied (Describe in detail):
III. CITY AGENCIESIINDIVIDUALS TO BE LOBBIED: (Pursuant to city code Section 2~82(g)
include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise to an
appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2-
482(ax4) 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) Any Financial, Familial or Professional Relationship
Design Review Board none
Board of Adjustments none
Planning Board none
Y
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
Hourly Amount - $150/hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). Hourl~r Amount - $150/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 ®No: Are you lobbvin4 on a present or pending bid for roods, 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 ®No: Are you lobbvinc on a pending application for a Development Agreement with the Clty or
application for chance of zoning map desiunadon or chance to the Citv'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 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 Berk as required by this
section but, shall not be required to pay any registration fees.
^ Yes ®No: Are you representlna a not for-profit corporation or entity without special compensation or
reimbursement .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of Principal/Client: __U~/
VI. LOBBYIST IDENTIFICATION:
PAL IDENTIFICATION:
^ Produced ID ^ Produced ID
Form of Identification Form of Identification
~
o ~ ^ Personally known (Lobbyist)
, ^ Personally known (Principal) '~~n
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VII. SIGNATURE AND STAMP OF NOTARY:
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State of Florida, County of Miami-Dade
State of Florida, County of Miami-Dade m~~.'o
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This day of ~ q,.~~, 2008' Sworn and subscriged before me
This day of , ZO(}S ~ ~ 3 ~ v
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Notarization of Lobbyist's signature S a e of Public Notary -State of Florida
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TO BE COMPLETED BY C TY CLERK'S STAFF ONLY ~ ~
Annual Registration fee: ]Yes [ ] No Amount Pai MC # Date Paid
Lobbyist Registration Form received and verified by:
F.\CLER\NATL\Forms\Lobbyist Registration Form.doc ~ ~ Revised 03/27/2008
Signat o 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 2-48~the Miami Beach City Code and all reporting requirements.
m
City of Miami Beach, 1700 Convenfion Center Drive, Miarni Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME:
Melissa Ross
CityClerk@miamibeachfl.gov
I understand that no later than October 1st of each xear, 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:
12/31/2008
Date:
FaCLER\LOBBYlST1L.obbyist Registration Form 32708.doc