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Paul B. Steinberg9~° ~~ . m 11AMIBEACH City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 _, r., e~_~ 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 modifi~n of 't ,f any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the City Manager or aryy_-city b'Q,~rd 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. Thrm ", `a specifically includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclugjpns. ase ._. •W refer to Ordinance 2004-3435. ,,,_ '` NAME OF LOBBYIST: (Last) (First) (M.I) _.:.. •• ~ cps l~ ~~~ G~ ~~ ~-- i~~~ ~~ ~L ~3~ ~ BUSINESS NAME AND ADDRESS (Number and Str et) (City) (State) (Zip Code) TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: ~~o e (~l 51A t~ C. NAME OF PRINCIPAL/CLIENT: 4 ca-o ©c~.t~ r~ ~l u2,i ~ ~ ~ ~ tk}v~u~. ~~ G= L 3 3 ~ 3 T BUSINESS NAME AND ADDRESS (Number and Street) (City) • (State) (Zip Code) ~ c-"~ ~ s Z n1 ~ ~ ~? Gc r=t.~; tJ;~~~ G'ti-..~.~>.~-~.4.-~.c E-C ,3 3 ~ '3 f TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)j • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ~N~ ~~~~ • IDENTIFY ALL PERS NS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATIOr~ PARTI~[ER HIP OR TRUST: ~ F+ kit ,1~ /i./L,L ~ C +~ ~ln~.•~t ~ /Z.~-~ ~ , u.SPECIFIC LOBBY ISSUE: ~~ ~~ `~ ~``~~~~ ~ ~ `~ ~ ~~~ 'P/ w,.zs -b ~~ ~ ~ fie.- C~ t 5-~- ;,~~ ~ '~ ~f`/1~~~ Issue to be lobbied (Describe in detail) Ill. 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 Individual/Title B) Any Financial, Familial or Pr ofess ional Relationship p ~ S~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): .n A) LOBBYIST DISCLOSURE: (Required) ~U _ (1 . _ _ d[~~ ~ 2 ~ ~ '~ B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST QQMP~NSATION): ~ ~ ! - (Required). ~ Cameo _U~.~ IL.rL,~C~ ~ "' 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 .ill No• Are you lobbvinq on a present or pendinq bid for goods, equipment or services, or on a present or pendinq 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 ~O: Are you lobbvinq on a pendinq 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. ^ Yes ~NO: Are you representing snot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: Signature of Principal/Client: VI. LOBBYIST ^ Produced ID Form of Identification ]\`bTAttY PtJBLtC-STAY ~~&n~ally known (Lobbyist) " ^ Beth rash j Commis&Ufn #DI~pTURE AND STAMP OF NOTARY: ';`~?.,~ Expires: THE , ~~: ._ LONDEDTHRUATLIU"C''-?OirJ~ CQ.,;.-; ::. ~~tate oti~lorida, County of Miami-Dade Sworn o and subscribed befoLe me This ~~ O day of ~~~ ~ ~ , 2009 Signature of Public Notary -State of Florida Notarization of Lobbyist's signature IDENTIFICATION: ^ Produced ID Form of Identification NOTARY PUBLICSTATE OF FTARII;A " -., Beth Barash Personally known (Princip` :Commission #DD7862~1_ -~= Expires: JUNE 24, 2U1:? BvNDED THRII ATLANTIC BGNDING CG., L"iC. State of Florida, County of Miami-Dade Sworn and subscribed befor~ me This ~'~ day of ~P2 ~ , 2009 Signature of Public Notary -State of Florida Notarization of Principal's signature Annual Registration fee [ ~ ]Yes [ ] No Amount Paid $ 1 J T~_MCR ~~~'~~'!~~Date Paid Lobbyist Registration Form received and verified by: , / ,- ,-:~ , G : F :~,r, ~,a,<x~.nf^^.<GC,: Revised 02/ 1/2009 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 /2-48 Miami each City Code and r#i~ requirements. Signature of Lobbyist: ~/ '` :- City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityC:Jerk@miamibeachfl.gov Tel: 305.673.741 1 ,Fax: 305.673.7254 LOBBYIST NAME: ~~`~`~~ ' J J~~'~ ~~r if" 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. ~ 3 3~~~ d Si re: Date: