Mitchell A. Bierman (2)
~IIe,E SC's i/!GL
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
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EMAIL:
I. LOBBYIST RETAINED BY:
~'nd Nn C~eGI~ V "l~ag ~
NAME OF PRINCIPAUCLIENT.
9~~0 ~y ~~i/e. ~~~l,~,l C'~e~~. ~~lag~ F'1.. 33/5,x!
BUSINE S NA AND A DRE S (Nu er and Street) (City) (fate) (Zip Code
05~ SbS-4 lal f3o5~ A16~_a.50a. rnlima~C? icvas.e~
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
u.SPEGIFfC LOBBY ISSUE:
~n~- Cr~-k J~l~ar~, 1
Issue to be lobbied (Describe in detail):
~~~
nl. CITY AGENCIES/INDIVIDUALS 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 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 said City
personnels' commencement of service with the City to the present date, stating the general nature of the subject
contractual relation.
A Full Name of Individual Title B An Financial, Familial or Professional Relationshi
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LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, bf' 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 arty aty 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 board or committee. The term
specifically includes the principal as well as any employee ergaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please
refer to Ordinance 2004-3435. ..
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHERJ:
A) LOBBYIST DISCLOSURE: {Required) w
~ ego (nt'.
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required).
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 la No: Are you lobbvina on a present or pending bid for goods eouipment 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':
application for chance of zoning map designation or chance to the Citv's Future Land Use
Mao?
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.
reimbursement. .
iE~----
Signature of Lobbyist:
Signature of Principal/Client
LOBBYIST IDENTIFICATION:
~ ~ ~ ~ ~ ^ Produced ID
Form of Identification
g Personally known (Lobbyist)
11. SIGNATURE AND STAMP OF NOTARY:
:, ~ fate of Florida, County of Miami-Dade
wom to anc~ subscribechbeforg me
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 ,2009
••.•.nr
ure of P -State o ' ~Y Pt~c - ~j P blic Notary -State of Florida
otariz of bb ' t,=s sign ,~~ aion EXp~~~ ~„of Principal's signature
,,oFn~ Commission # 00 SOf33
~~.,
CITY CLERKS STAFF ON
Annual Registration fee: [ )Yes [ j No Amount Paid S MCR # Date Paid
Lobbyist Registration Form received and verified by:
Fc\CLER\$ALL\aFORMS\LOBBYIST FORMS\Labtryist I2isLration Form 211p9.dae ~ Revised 02/11/2009
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-~ 82~of the Miami Beach City Code and all reporting requirements.
-- ---
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTNER):
A) LOBBYIST DISCLOSURE: (Required) N
`~ z`~o Inc'.
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
O..n,~Procurement Issues":
^ Yes I~ No: Are you lobbying on a present or pending bid for goods. eoutpment 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 Fystate Development Issues":
application for chance of zoning map deslttnation or chance to the City's Future Land Use
Mao? .
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 anotfor-profit
corporation or entity without speaal 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 pey any registration fees.
l.J Yes ^ No: Are you representing snot ior-profit corporation or entity without special compensation or
reimbursement..
V. SIGNATURE UNDER OATH: ~~
-~.
A111 Af~TAOG~ qeT /1G GA AV VGAD AAII 1 I~SSVIL~T Duw1 I
/
Signature of Lobbyist
r
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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:
LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Lobbyist)
SIGNATURE AND STAMP OF NOTARY:
of Florida, County of Miami-Dade
~ to and subscribed,before me
PRINCIPAL IDENTIFICATION:
Produced ID
,,,/ Form of Identification
LY Personally known (Principal)
State of Florida, C
Swor an~subsa
This~day of
MONIi]UE SARRAFF.
~ PubGc • S4A P bli
Coco ?ion ExpA~isi~~ ~: f P
Annual Registration fee: j ~ ]Yes [ . ] No Amount Paid
Lobbyist Registration Form received.and verified by: _
of Miami-Dade
Paid
Cr K
5
Form 21109.doc
I{(, DISCLOSUR6 OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
/Zg71cOR 07'HERf:
/~ LOBBYIST DISCLOSURE: (Requb~ad) ~~ ,
ego in~~.
B) PRINCIPAL'8 DISCLOSURE (OF LOBBYIST COMPENSATION);
(Required).
The following informatlon must be answered:
1j Pursuarrtto Mlaml Beach City Cade 5eotion 2488 Entftied "Prohibited Campelgn Cor>brlbutions By Lobbylsts
O~n~Pmcuromertt Issues":
^ Yes l~ No• Are you iobbvlna on a present or oendlna 61d for aoods enuinment or eerv(cea or an a
presentor pending award for aoods. eauipmentorservice?
2) Pursuant to Miami Beach City Code 2-490 Erdltled 'Prohibited Campaign ConUibutions By Lobbyists On
Real Fystabe Development Issues":
M. 2p?
3j Pursuant to Miami Beach City Code 2-484 {h) Any person (except those exempt from the definition of
'lobbyist" as set fiorih in Section 2-481 above) who only appears as a representative of snot-for-profit
corporation or entity without special compensation or reimbursement forthe appearance, whether direst, or
indirect, to express support of or opposition to any item, shall register with the clerk as requirod by this
aeotan but, shall not be required tp pay any reglstralfon fees.
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~ iTH:
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L 3 O L B X ND TU 8 CO PE 8 0
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VE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTiNO
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' Sigrrature of Lobbyist
..
5 ` S , ~y `fret all of
l
!';.„'peon the foregoing facts are taste and correct and that I have read or am'tamiliar with the
2-4 ofthe Miami Beach City Code end all repotting t~quk~emerrts,
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y N0, ?, .~.d «NO r! 710N: PRiNC1PALIDEN'i'IFICATiON:
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N1C. tJ~e.{'(hG~l'~ t S ~
~ ~ Produced iD
~ t-eP re send ay r} ~~ 'f Identification Form of Identification
C Cf,~ 5 A.'~"'1 al~j Y1st} ~ LY Pereonaliy ta~own (Pdnoipa~
~~ ~~U J >Dade State of Florida, County of Miami-Dade
p .
L~~. E 4~ ne Swo ar~aubsal ed ~„ . PRADC
_•2Q09_ , _ Tnig~day of. vw.nnf
N~-P Pu6tic .
Annual Registration fet: [ j Yes [ . ] No Amount P:
Lobbyist Registration Form received,and verified by:
3
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, vaww.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.7411 ,Fax: 305.673.7254
C i tyC lerk~m i a m i bea c h fl . gov
LOBBYIST NAME: I ~` ~/8t''/~14~.
I understand that no later than October 1st 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 of lobbyist withdrawal in writing.
Signature:
30 o q'
te:
F:tC~ERILOBBYiS'rll.obbyist Registration Form 32708.doa