Martin, Scottm MIAMIBEACH
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 of 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 bond or
committee. The term specifically includes the principal as well as any employee engaged in lobbying activities. The
term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST: (Last) (First) (M.I.)
Martin Scott
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
Martin Outdoor Media, Inc. 152 NE 167 St. Miami FL 33162
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
(305) 944 - 7208 (305) 655 - 9949 scoff@gobenches.com
LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT:
Martin Outdoor Media, Inc.
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
Martin Outdoor Media, Inc. 152 NE 167 St, Miami FL 33162
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
(305) 944 - 7208
Fill out this section if principal is a Corporation, Partnership or Trust
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
Scott Martin, President
IDENTIFY ALL PERSONS HOLDING, DIRECTLY CR INDIRECTLY, A 5% OR MORE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
Please see attached
II. SPECIFIC LOBBY ISSUE:
Bus bench advertising
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code Section 2-482(g) include a
statement of the extent of any business, financial, familial, professional or other relationship, giving rise to an
appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2-
482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the
commencement of service of City personnel to be lobbied.}
Aj Full Name of Individual/Title B) An Financial, Familial or Professional Relationshi
Mayor None
Commissioners
City Administration; City Attorney's Office; None
Cit Boards; Cit Committees
MIADOCS 3413214 1
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
None, other than normal compensation
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N O u
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). None, other than normal compensation
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 IRI No: Are you lobbvina on a present or pending bid for goods eauipment or services or on a
present or pending award for Goods. eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^Yes 6a No: Are you lobbvina on a pending application for a Development Agreement with the City or
application for chance of zoning map designation or chance to the City'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 clerk as required by this
section but, shall not be required to pay any registration fees..
^Yes 6d No: Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
Signature of Lobbyist: X
Signature of Principal/Client: X
VI. LOBBYIST IDENTIFICA'
^ Produced ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Swor and subscribe efore
This day of ~ 201~'Q~
a ~ c~~U
nature of Public Notary -State of Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
TO BE COMPLETED BY CITY CLERK'S USE ONLY
Annual Registration fee: [ j Yes [ j No Amount Pald S MCR # S Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\LOBBYIST1Lobbyist Registration Form 32708.doc Revised 03127!2008
^ Produced ID
Form of Identification
Personally known (Principal)
~"~""~. ANA PAULA SALT
MY COMMISSION # DD823538
E3Q~fI2ES: Septanba 27, 2012
State of Florida, County of Miami-Dade ,~oo.,"`~ v r~.r,~,ryan~.co.
Swor and subscribed efore mqe
This day of~'/~ 200, 1
r! 'M'° /~
Signature of Public Notary -State of Florida
Notarization of Principal's signature
I do solemnly swear that all of the foregoing facts are true and correc that I have read or am familiar with the
provisions contained in Section 2-482 of the Miami Beath City flode~nd alVra~nrr-renuirPmantc
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK office CitvClerkCilmiamibeachfl.oov
Tel: 305.673.7411, Fax: 305.673.7254
LOBBYIST NAME: Scott Martin
I understand that no later than October 18L of each vear, I must file the following forms, pursuant to Section 2-485 of
the Miami Beach Ciry 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 for lobbyist withdrawal in writing.
x x o ~' ~
Si ~ture: Date:
MIADOCS 3413214 1
Martin Outdoor Media, Inc.
Disclosure of Interest -Persons holding more than 5%
Tom Comeau
Scott Martin
David Aelion
MIADOCS 3415615 I