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David R. Custin1 ~ t7lfC/~'N (-ZlkF~~ C S~lu~r tv- ~FP as-a~~®9 r . .a 4 . ~'"~ m ~ .,, ~ ~ Y~.' .: ' ~ r . . ! ~ ~..~~6.,H~. ~.w 2049~"~B 23 Pit 3~ 2I -'~ City of Miami Beach Office of tfie City Clerk 1700 Convention Center Drive, Miami Beach, 'FL 33139 LOBBYIST REGlSTRATlON EE3FtM Lobbyist means al! persons empicsyed or retained, whether paiC w pat, by a principal who Seeks t0 encourage the,.passage, defeat al modifiCStian of any ardinanee, resoiuticm, ac~n or decision of any commissioner any action, decision, recommerufation of the City Manger or any city board yr comrtutbee; Qc any action, decision or recommendation of atry'raty personnel during the time periai of the entire decrsion-making process on .Such ackan, decisiCn'or recommendation that f~eseeabiy will be heard ar reviea2d by the city commission, or a city award or camm~tee. The term Specifz~Qy includes the prinapai'as wep es any employee engaged ir1 tohbyirtg atxivities The term "lobbyists" hoe spactfrc Qzalusi~s. Piesse refer to t}rdinence 2004-3435, A tVAMi: Vt IVCfCSTt,i: tt-a&IJ r triwy ~•••.•i 6401 SW 113 PL, Miami, fL 33173-.1083 BUSINESS NAME ANO ADDRESS (Number and Streety (city} (State) (2!p Code) 305-412-3772 305-412-3773 ~ ~u s~~ ~ ~ vl~t/~~r,-r 7 ~~t ,, c n,h TELEPklQNE NUM8Ef2: FAX NUMBER: EMAIL: h LQBBYtST RETAINED BY: American Traffic SoCutions, Inc. ~~r~tw~'~G ~-v NAME OF PRINCIPALlCLIENT: BUSt ES8 NAM D Af7 f2ESS (Number and Street] (City) (State] ip Gode} D -- .- O L? . CGS ` ~ e" S L-. Gd'y/ TEL P ONE UMBER: FAX NUMBER: (Optional) EMAIL: (Optio 'at) Fill out this section. if princlpai is a Corporation,' Partrtership ar Trust [Section Z-A82 (c]] ~~ ~''' tdAME OF CHIEF-.OFFICER, PARTNER, OR BENEFIC{ARY: -JG ~'1 fs ~ v! Q~ ~~d r • {QENTIFY ALL PERSONS tiOLDiNG, DIRECTLY OR lNDfFtECTLY, A 5% OR MORE OWNERSHIP INTEREST fN SUCH CpRFORATiON, PARTNERSHIP' OR TRUST: --^ l M Q/C~i/ f.~ G~ C~7`/dnl.S n.SPECtFIC LUBBY ISSUE: Ca'`~-S" ~~-~~~,? ~~n'c- ~~~ ~~~ 4 Z- o$~ Issue to be fobtsied tQescribe in detail: nI. CITY AGENCIES/INl'31VIDUAL.S 7d BE LOBBtE©: (Pursuant to .City Code Sectkrn 2-<82(g} include a statement of the extent of any business, ~nart;ciai, familial, professional or'other relations[tip, giving-,raise to an appearance of an'itripropriety, with any £ity'persorlnel saught;to be lobbied, fiurther, pursuanYto City Code Section 2- 4tf2(a](4] Include a statement of any ...contractual selationahip (paid or unpaid] #rom. 12 months preceding the comnteacement of service ofi City. personnel to be Iotsbied.] A Full Nisme of Individual Title B An FirEanciat, Familial or Prafiessional Relatianshi City Manager & administrative staff None Mayor arld Clty COn1mISSlOn Comm Wolfson: design & printing; direct mail;photography services. ~n/A~ ~Cr //. _._~. .. .~... ~~...~+w.r.w~ s. r. r > •xMVIiL 1, ! L/f f v~ ' A} LpBBY1ST DiSCLflSUf2E: (Required) • `~-~~ moo ~e P B} PRINCtPAt_'S D Ct_ iJRE (OF IS~BBYiST MRENSATtflN}: The fallowing 9nformatlan mrust' be answered: 1) Pursuant to Miami Beach Gty Code Section 2~8 Entitled "Prohibited Campaign Contributions fay Lobbyists ~n Procurement Issues": N .Are u lab in on nt ar din bid far Dads e i ment ar' rvic or o» a present or oending award for~,oods eCtuicsment ar service? 2) Ptansuant to Miami Beach C"sty Code 2-491} Entitled "Prohibited Campaign Contributions By Lobbyists tin Real.Este#e Development Issues": Yes. ~ No; Are ou lab in on a endin licatian far a [#eveto ent A e w the C or a Ilea#iott for than"e af'zanin m dssi nation or c n e the: C ,s re La d t1s 3) Pursuant to Miami Beach City Code 2-484 (hj Any person (except those exempt from the definition cf °lobbyist" as sef forth in Section 2-+181 above) who only appears as a representative Csf anot-fcx-profit corporation or entity without special compensation ar rairnbursement for the. appearance, whether direct, or, indirect, to express support ai or opposition io any... item, shall regis#sr with the clerk as required by this' section but, shall not be required to pay any registratipn fees.. ~/ No: Are o re resentn a not-fcr- rcafit ca aradnn ur anti wi ut s alai cam snsattn r reimbursement . V. SIGNATURE tJt313ER OATH: do solemnly swear at ail o he re Ding facts ce true and correct and that I have read or am familiar with the provisions contained 'on 62 Mi i 'Cade~and afl reporting requirements. Signature of Lobbyist: _ Sigrsature of PrincipaUCiient: Vl. LOBBYtS7 t ~ I+1~Tf lC TtON: PRINCIPAL tDEN~'tFICATION: Produced iD ~ 23 S ' 1 ~ ~ ~~ ' ~~' Produced 1 D ~ Z(~ ' / q ~ ~" 7 7"' Form of Identification Farm of Identification ^ PersQnaliy known (Lobbyist} (,~ Personalty known (Principal) . VII. SIGNATURE Al+lt} STAMP OF Nt'~TAt2Y. State of Florida, only of Miami-Dade State of Florida unty of Miami-[}ode Sworn to~nd rib fare me Swam a' fore me This of , 20118 This a , 20118 ~'' s tary - tote of Florida __ Sr of Publi o o 'gnature MIIG'tlsM~i1M0~-E>~pM~ ~ ~~ 2011 ~ IY'otari _ iitl~~ ~r4 "' as, N~ Ru01k . gt#te of Fiotldsa . TO SE Cfl~IRt.E7ED BY CITY CLERK'S E~~^ 2' 2011 n s o Amount Paid 3 l c ~ ived and verifier! by: ~ f .1 NslionM F: CL a~HA'1 0 - -~ ~ ~~ r~~0 ~_ tJ ~ ~ 1'~~ -. _ __ _ ~ °~ ~~ / __ 'y i ~'~ . ~=-w d ~. ~ ..: ~. 6 ~ ~ I ~,..~ ~. ~-° °~ ~...a~ ~ ~ City of Miami Beach, 17b0 Convention Center Drive, Miomi Beath, Florida 33134, wvrw,miamibeachfl.gav CITY CLERK Office CityCferk@rnlamibeachN.gov Tel: S(a5.b73.741 I ,Fax: 3(35.673.725 J , C~BBYEST NAME: v'~ ~ ~ S ~~ ~'1 f understand that na later than Aber 1 s# of each .yetsr, I must file the following forms, pursuant to Section 2.485 of the -Miami Beach City Code, with the City Clerk`s C1ffice for all active lobbying issues. ~ ~ l©bbyist Expenditure Form 2~ pisclosure form .failure ro file these forms an a timely basis wi[I result in my name being transmitted to the Ntiami-Dade County Commission an Ethics and for code violation eva,ludtion. In addition, once an issue f have regis#ered to tabby on has been resolved, f am required to 'rrnmediotely notify the City Clerk's Offictr of lobbyist withdrawal irl writing. Signature: ate: Revis~cl €3~;0~~2~2~x