Howard S. Frankr~~S
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 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 inGudes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please
refer to Ordinance 2004-3435. j ~
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NAME OF PRINCIPAUCLIENT: ~~ ~/~~
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
u.SPECI I LOBBY I SUE: J
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Issue to be lobbied (Describe in
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 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 IndividuaAl/Title B) An Financial, Familial or Professional Relationship
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• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
I. (LOBBYIST RETAINED BY: 11
tV. OtSC:LOSURE CIF TERtytS AN0 AMOUNTS Of Lt'Jt3$YtST COAApENSATiClN {DISCLOSE WHETHER NOtHtLY, FLAT
RATE OR CiTJiER):
ay tt7g8Y1S~t~SCtt~~suRE: (,~qu-redy
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B} PIZiNCIPAL'S t)ISCLOSURE (?JF LOBBYIST COMPENSATION}: t „~~~~
{Required}. `"7` t
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The fallawtng informatton moat be answered:
i) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
tJn Procurement Issues".
^ Yes ~No Are you labtrvina on a present or ~ndina bM fat aaods eauioment or setvtces or an a
atesetyt or uetlydina award fQr spade. eaultstneet or setviee?
2) Pursuant to Miami Beach City Cade 2-490 Entitled "Prohibited Campaign Gontributians 8y lobbyists Cki
Real Estate l~±veloprnent issues"
^ Yes ~ No• Are you tats#IVino on a oendina aanlica n fat a DevetotsnneM AareenueM with the City or
8ppiicatfan for chana+s of zanitra moo tt~Mnatian or edarttur ~r the Ci+br's Future Land Use
Mats?
3) Pursuant to Miami Eeach Crty Code 2-484 (h} Any person {except those exempt from the de6nidan of
"tabbyist" as set forte in Sedan 2-4 3t alcove) who only appears as a representatnre of a not for-profd
corporation or entity ~nthout social compensation ar reimbursement far the appearance, whether direct, or
indirect, to express ~uppc~rt eef or oppo~aition to any gem, shad register with the clerk as required by this
section but, shall not oe required to pay any registration fees
Y SiGNATt~E UNDER C>ATti;
Signature of Lobbyist:
Signature of PrincipaU(
YL LOBBYIST IDENTIFaCATiON:
^ Produced ID __
,,.,/`~ Fo°m of tdenuficaticn
tld' Personally known (Lsbbylat)
PRINCIPAL iDENTtFICATtON:
[~ Produced ICI
Farm of identif~catian
Personally known (Principal)
SIGNATURE AND STAMP OF NOTARY:
e of Flortda. County of Mi ~rni-Dade
•n to and subscri fc re me
.~. day of~~C~~,,,_,~. 2009
State of Florida. County of Miami-Dade
Sworn end subsCntfed before me
This day ofi , 2009
- ,.taUe of Flariri a Signature of Public Notary -State of Fksrida
s segnsture Notarization of ~-cioal's signa~re
~~ _TO BE COMPLETED HY CtiY Cl•EigC`Sk STAf
Ragi~atlon taw ("Y `st ( ~~ tfo Amousrt Pa1d i' -^ 1MCR
st wgl+Itratlon Form rec.~vad ana vrrtfl.d or•
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I do solemnly swear that ail C I the for~r+g facts are true ~rnd ,orre~ and that i have read or am familiar with the
provisions contained in Sedia~ 2-42 p! the tVtiarni Beata City Code artd all repartitx, requirements.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
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A) LOBBYIST DISCLOSURE: (Required)
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 ^ No: Are you lobbvinp 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 ^ No: Are you lobbvinp 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 ^ No: Are you representing snot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist: !° / ~~
r
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
t
i ^ Produced ID
Form of Identification
i
~ Personally known (Lobbyist)
IVII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
Zhis .~~ day of /~iL~!'i/ , 2009
Signature of P~blic Notary -State of Florida
Notarization f Lobbyist's signature
PRINCIPAL IDENTIFICATION:
0 Produced ID
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This day of , 2009
Signature of Public Notary -State of Florida
Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid S MCR # Date Paid
lobbyist Registration Form received and verified by:
F:\CLHR\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form 21109.dac Revised I
I do solemnly swear that all of the fore g facts are true and correct and that I have read or am familiar with the
provisions contained in Section 2-48 the iami Beach City Code and all reporting requirements.
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk@miamibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
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L~~tYIST NAME:
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.
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Signature: Da e:
F:ICLERtLOBBYIST1Lobbyist Registration Form 3270$.doc