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Tachmes, Alexanderm 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.) Tachmes Alexander I BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) _ Shutts 8~ Bowen LLP 201 S. Biscayne Boulevard, Suite 1500 Miami, FL 33131 TELEPHONE NUMBER: FAX NUMBER: EMAIL: (305) 347 - 7341 (305) 347-7754 atachmes@shutts.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 [Section 2-482 (c)) • 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.) A Full Name of IndividuallTitle B An Financial, Familial or Professional Relationshi Mayor None Commissioners City Administration; City Attorney's Office; None Cit Committees; Cit Boards ~• r~ Mar ,27 09 12: 58p p,3 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLQSE WHETHER HOURLY, FLAT RA 7'E OR OTHER): A) LOBBYIST DISCLOSURE: {Required} $ 450.00 per hour B} PRINCIPAL'S DISCLOSURE (OF LO©13YIST COMPENSATION): {Rrsquirad). $ 4.`rO.OD per hour The following Information must bo answered; t } Pursuant to Miami poach City Code Section 2-4f38 Entitled "Prohibited Campaign Contributions By Lobbyists On Prgcurement Issues"~ Yos_QQ Np: Are you lobbying on a~resQnt pr pending bid for oopdS eduipmcnt or services or on a present or pondinp award for Goods. Equipment or sorvlCe? ?) Pursuant to Miami 8cach City Code 2.490 Entitled 'Prohibited Campaign Contributions By Lobbyists On Real Estate bevelopmant Issues": Yos_~ Np: Ar~ou lobbyintr on a nsndlnq application far a D~v~lopmont Aprooment with the City Or appiication_for GhZnCV of zoning map desist nation or thence to the City's Future Land Use tNan~ 3} Pursuant to Miami Beach City Code 2.484 {h) Any person (except those exempt from the definition of "lobbyist" as sot forth In Section 2-481 above) who only appears as a represontativp of anot-for-profit Corporatipn Or entity withqut spetiai componsatiorl Or reimbursompnt for the appearance, whether direct, or indirect, to express Support of or opposition to any item, shaA register with the clock as required by this section but. Shall not be required to pay any registration fees.. j~Yes Qc NO: Are you repre5entinp a not-ipr.profit corooratlpn or entity without spacial Compensation or reimbursCmant. SIGNATURE UNpER OATH: Signature o1 Lohbyis[: Signature of PrinClpa!/Client: ~^ VI. LOBBYIST IDENTIFICATIO ^ Produced i0 Form of identification personally known (Lobbyist} VII, SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sw t~{ .ands b~cribo before me T day of~tapl~ , ~OOt3 ~ ~~~ Signature of Public Notary -State of Florida Notarization pt Lobbyist's signature Annual Rogislration POrm received and vCritied by: _ ~bylst F~ectlslrolion Fprm 3270t}.doc tP~~r P~eln R~ IT~I * ••~# Y t':i~ t~,8a'ISSIONf~B~~ to i~r_S.f9cn:2ry23,2013 ~+,~~ ~,~.+~ Bataea thu ~,~ tkta,y Services PRINCIPAL IDENTIFICATION: ^ Produced IO __ / ~ ~ Form of Identification L~ Personally known (Printlpal} ~'°'"4a ANA 1'niJ(_A SALT M}' L•I)M1tlSSl<>N t: DURZ35.IK S4nte of Florida, county of Miami•bad ''s„~ t'at'lltts:kz,,,y„t,.T~~,:urz .ciWOfn t 8,1d 5Ut]~CRbt3 before the 'x"".~'r~pY I'I. W,I"rt~UlYarmN j~M1•,R'. Cu This~day of ~, 20~ q ~. Signature of Public Notary -State of Florida Notarixation of Principal's signature D t3Y CITY CLERK'S -r _ k{CR # S- PAGE 3113 ~ RCVD AT 31271200911,38;12 AM Eastern Daylight Timed ~ SUR;FAXSERVERf9 ~ DNIS:1754"CSID; ~ DURATION (mm•ss),04•~2 I do solemnly swear that all of the for Ding facts are true - nd correct and that I have road or am familiar with the provisions Contained in Section 2-48 of Miami Beth Gio end all reporting requirements. IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $ 450.00 per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 450.00 per 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 6a No: Are you lobbvinq on a present or pending bid for goods 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 6a No: Are you lobbvinq on a pending application for a Development Agreement with the City or application for chance of zoning map designation 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 clerk as required by this section but, shall not be required to pay any registration fees.. []Yes 6a No: Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: r~tc~w. 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 contained in Section 2-482 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: ~( VI. LOBBYIST IDENTIFICA ^ Produced ID Form of Identification ^ Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed before me This _ day of , 2008 Signature of Public Notary -State of Florida Notarization of Lobbyist's signature PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification Personally known (Principal) ~'"~e, ANA PAULA SALT ~~I~t MY COMMISSION # DD823538 State of Florida, County of Miami-Dad ~`~„~'.~ EJQ'~~s~~r27.2ot2 Sworn and subsc,,ri~b~ before me ''"04''"°r"R'' Fi'"""''°'~°"""~•c°. Thisday~of'f~, 201$ 99 ~~' 7 ~X~J[-(J Signature of Public Notary -State of Florida Notarization of Principal's signature TO BE COMPLETED B CITY CLERK'S US ONLY Annual Registration fee: [ ]Yes [ j No Amount Paid S M # S Date Paid Lobbyist Registration Form received and verified by: F:\CLER\LOBBYIS11Lobbyist Registration Form 32708.doc Revised 03/27/2008 m P~,~.IA.i`~11BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, vvww.miamibeachfl.gov CITY CLERK office CityClerkta'~.miamibeachfl.gov Tel: 305.673.7411, Fax: 305.673.7254 LOBBYIST NAME: Alex Tachmes I understand that no later than October 15i 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 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(31 aq Signature: Date: Mar,27 09 12:59p Martin Outdoor Media, Ync. 1]isclosure oi`Interest - persons holding moan than 5% 7'om Corrleau Scott Martin David ~e~xo11 MIAI)U('ti ldl9(,IS 1 p.5 PAGE 5113 ~ RGUD AT 31211200911;38;12 AM (Eastern Daylight Time)"SVR:FAXSERVERI9 ~ DNIS;1154 ~ CSID. ~ DURATION (mm•ss);04.52