David Anderson/Ameresco, Inc.m MIAMIBEACH
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 bond 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.
NAME OF LOBBYIST: (Last) (First) (M.I.)
Anderson David
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
Ameresco, Inc. 111 Speen Street, Suite 410 Framin ham MA 01701
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
508-661-2200 508.661.2201
LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT:
Ameresco, Inc.
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
_ 111 Speen Street, Suite 410 Framin ham MA 01701
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
508-661-2200
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
George Sakellaris
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE
OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
George Sakellaris
II. SPECIFIC LOBBY ISSUE:
Proposed contract between City of Miami Beach and Ameresco, Inc.
Issue to be lobbied (Describe in detail): Proposed contract between City of Miami Beach and Ameresco, Inc
III. CITY AGENCIESlINDIVIDUALS 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 the
commencement of service of City personnel to be lobbied.)
A Full Name of IndividuallTitle B) An Financial, Familial or Professional Relationshi
Mayor None
Commissioners
City Administration; City Attorney's Office; None
Cit Committees; Cit Boards
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
No special compensation (lobbyist is an employee of the company)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). No special compensation (lobbyist is an employee of the company)
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbvists
^Yes 6a No: Are you lobbvina on a Dendina application for a Develoament Agreement with the Citv or
application for chance of zoning maD designation or chance to the Citv's Future Land Use MaD~
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 anot-for-Drofit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIF
^ Produced ID
Form of Identification
~( Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
N~ K~~~d~i~S
State of I~leride, Countyirii=B~de
Swarmand subscribed before me
Thist~ day of krs ~ , 200~~
l
Sign ure of Public Notary -State o1`FitrridaN ~
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Principal)
NA- Iw~~~ ~.5~
State of ~Flartda, County ef~NiartrtTl~de
Sworn tQ nd subscribed before me
Th//i~~slA ~ay of /A'v ~Sf,~,~20Q8
_l1~ UI "'~M/Ifi
Sign~ture of Public Notary -State of Florida
Nota ization of Principal's signature
TO BE COMPLET D BY CITY CLERK'S S
Annual Registration fee. ]Yes [ ] No Amount Paid S M R # S Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\LOBBYIST1LObb ist Re istration Form 32708.doc Revised 03/27!2008
~~'
a ~`~ ~
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
I do solemnly swear that all of the fj2or~egoii f t~re true ~i{d rect and tJ~ I have read or am familiar with the
provisions contained in Section 2-48 f t mi Beach S3(ty ode and all n~dortina reauiremPnts
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.oov
CITY CLERK office CityClerk .miamibeachfl.oov
Tel: 305.673.7411, Fax: 305.673.7254
LOBBYIST NAME: David Anderson
I understand that no later than October 1`t of each vear, 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 ffice for lobb 'st drawal in writing.
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ignature ~1~~s~ 6 ' ~~~~
Date:
MIADOCS 3621767 1