James R. MacKenzie/Pestana Miami LLC (2).~
~~
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 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 20043435. i ~ Q
/-1 dl~ ON .?.LrD 4 f11~ S /mss
NAME OF
BUSINESS NAME AND ADDRESS
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TELEPHONE NUMBER:
(Last) ~ (First) ~SZ ~ (M.I)
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(Number and Street) (City) (State) (Zip Code)
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FAX NUMBER: EMAIL: / ,
l°W~ks
1. LOBBYIST RE AINED BY:
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NAME OF PRINCI AUCLIENT: Q C /~ NHS
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 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:
IL E~C~j~ ~~ OBBY~I.S~~~~„„ tj 3 ~c~~L ~`! ~"~L~~ [~ ~Q/~7~~~J ~l~
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Issue to be lobbied (Describe in detai~yi "
ul. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED.: Pursuant to City Code Section 2-482(8) 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(ax4) 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 Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ~/ JJJJ / ~
/VO ~ oYGf'l.~ ~/ '•
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMP~N~
(Required). O ~~{-- / ~ i /~ Sc{, • - ,r~ ~ ~
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 Q4No: Are you lobbvina on a present or pending bid for aoods eauiament or services or on a
present or pendina 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 ~..Alo: Are you lobbvina on a pending application for a Development Agreement with the City or
application for chanae 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 snot-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 anot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1sT OF EACH YEAR EACH 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 P IN NDAR YEAR. A STATEMENT SHALL
BE FILED EVEN IF THERE HAVE BEEN NO EXPEND RE O NSATION DURING THE REPORTING
PERIOD.
~~~
of Lobbyist
I do solemnly swear th all of t e for cts re true an correct and that I have read or am familiar with the
provisions contained in ectio -48 Miam~ each City ode and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client: ~ ~ . u^'~ ~ i'r ~`
VI. LOBBYIST IDENTIFIC , ION: PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
~' °~~;=: Notary Pubkc -State of Fonda
VII. SIGNA - $ryQs~[~,~~~ Zoos
` ± ~orc Commisson # DD458380
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State of Florida, ouN 'Z1~ Mia~eWational NotaryAssn.
Sworn to and su s rib a re
This /'~ day of , 2009
Signature of Public Notary - State o lorida
Notarization of Lobbyist's signature
0 Produced ID
Form of Identification
ersonally known
- ~`"- °°<i;-.- Notary Public -State of Florida
_ ; • = My Commission Expires Aug 4, 2009
State of Florida, Cou "~ P~'_Daa~~~~C~~ommission # DD458380
~~~~~~~~ 88tttfed By National Notary Assn.
Sworn an subscribe
This /a~ day of /~{ , 2009
a G
ignature of Public Notary - Sta a of Florida
Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY ~"
Annual Registration fee: [ ]Yes [ ] No Amount Paid $ MCIj.~ Date Paid
Lobbyist Registration Form received and verified by: ~,~,6 ~/~j~ p~
rc~c~.rtt~~~.~.~~~osrs`~,r.osa~zs~ ors°,~~b~,~ist a~~istratlac~ c~rz~: ~~s~~.os~~ Revised 02/11/2009
i~ k ~~ , ~ ~~~~. ~ `vr ~ i t '.0..i..
City of Miami Beach, 1700 Convention Center Drive, Miomi Beoch, Florida 33139, veww.miamibeachfl.gov
CITY CLERK OFFice
Tel: 305.673.741 1 ,Fax: 305.673.7254
CityClerk@miami beachFl.gov
LOBBYIST NAME: ~'~~~ ~~
'~~
I understand that no later than October 1st of each Xear, 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 j 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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Sign ure: ~- `~ / D te:
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Rs~visarJ 02/04/2006
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