Mitchell A. Bierman (3)
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 modifcation 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 board 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.
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NAME OF LOBBYIS (Las) (F rst) (M.I)
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RETAINED BY:
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NAME OF PRINCIPAL/CLIENT
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(Zi Code)
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Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (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:
II.SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail): V ' J
lll. 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(aj(4) include a statement of any contractual relationship (paid or unpaid] from ~2 months preceding sale: 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) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHERJ:
A) LOBBYIST DISCLOSURE: (Required) 1. ~ CA
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 lobbying 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 Lid No: Are you lobbying on a pending application for a Development Agreement with the City or
implication for change of zoning map designation or change 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
"IobbyisY' 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, shah not be required to pay any registration fees.
reimbursement. .
V. SIGNATURE UNDER OATH: ~ ` ~""'r
ON OCTOBER 1sT OF EACH YEAR E H LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH LISTING LOBBYING EXPENDITURES AS WELL AS COMPENSATION
RECEIVED IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL
BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING
PERIOD.
t Oe ~ .
Signature of Lobbyist
1 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/C
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
~ C. NIACEi'
_ :.~ MY CAMMISSION # DD 157411
Personally known EXPIRES: February it, 2012
BondeditxuNawWbtcut~dmnN~p
VII: SIGNATURE
State of Florida, County of Miami-Dade ~
Swom to,and subscribe~l_before me
Thisil Gi daa~ of GI.U~. 2009
3ignay(ire of POblic Notary -State of Florida
Not nation of LobbvisYs signature
IDENTIFICATION:
Form of Identification
known (Principal)
State of Florida, County of Miami-Dade
Sworn end subscribed Before me
This-, (,, day of ,(VlQ-~s/,"2009
OF
TENNESSEE
NOTARY
PUBLIC ,~i^
~'~oN cov`e`
~IL~II4 LUIG VI r"UUlll. IV VLdIy - JLd LC VIA
Notarization of Principal's signature
~G.~.~.aA.~e.~
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid $ MCR # Date Paid
Lobbyist Registration Form received and verified by:
F:~CLERt$ALL~aFORMS~iOBBYSST FO3ih1S~Labbyist Registration Form 2S1U9.doc Revised 02/11/2009
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
PRINCIPAL IDENTIFICATION:
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 lobbying 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 L1r No: Are you lobbying on a pending application for a Development Agreement with the City or
application for change of zoning map designation or change 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.
reimbursement. .
V. SIGNATURE UNDER OATH:
PERIOD.
~~ rt . •
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 IDENTIFICATION:
^ Produced ID
„,• ~ BSAN C. MACET
. ' ~:
MY COMMISSION M DD 757411
Personally known EXPIRES: February 11,2012
nr n. eorKfed Thru Notes P~bAc UpdrrnvtMM
VII. SIGNATURE
State of Florida, County of Miami-Dade
Sworn to,and subscribe before me
This ~da of i , 2009
''~~~'/Gt' ~~t t Ci,('i~. l~n i'r~~
Signa~Gre of Public Notary -State of Florida
Not ization of Lobbyist's signature
uced ID
~-5d
Form of Identification
ly 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
r~E,,,
TO 6E COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid $ MCR # Date Paid
Lobbyist Registration Form received and verified by:
~, z~ .x. ts., ~f_i. ix. .gaaS~1 x" .,ids>:~.asY ,~<`:#~s.~:S.l.i7d}= 3 ~. ~s",€,~;az . 1.a1.. .:.~Ja. ReVISed D2~11~2DD9
Cifiy of Miomi eeoeh, 1700 Convention Center Urive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.7411 ,fax: 305.673.7254
CityClerk@miamibeachfLgov
LOBBYIST NAME: M~c~~. ~~c'~'~
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: Date:
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