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Mohsin Huq/Ameresco, Inc.m P~^~IAi~nIBEACH 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.) Huq Mohsin BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) Ameresco, Inc. 111 Speen Street, Suite 410 Framingham MA 01701 TELEPHONE NUMBER: FAX NUMBER: EMAIL: 508-661-2200 508.661.2201 LOBBYIST RETAINED BY: NAME OF PRINCIPAL/CLIENT: Ameresco, Inc. BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 111 Speen Street, Suite 410 Framingham 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 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 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 the commencement of service of City personnel to be lobbied.) A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship 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 Lobbyists I-IYes ~ No: Are you lobbying 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: ON OCTOBER 15` 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 PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. /fin 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 Mi~Beach City fgg~de a~td all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: X ` I. LOBBYIST IDENTIFICATION: s ~ f'~ ~t ~~-'~ Produced ID H~~~j3'~o~ "~~~'~ ~ ~~ Form of Identification ~$ ^ Personally known (Lobbyist) g S II. SIGNATURE AND STAMP OF NOTARY: tate of Florida, County of Miami-Dade worn to and subscribe befor e his ~ day of , 20( Signature of Public Notary -State of Florida Notarization of Lobbyist's signature TO BE COMPLET D BY Annual Registration fee. ]Yes [ ] No Amount Pai Lobbyist Registration Form received and verified by - F:\CLER\LOBBYIST\Lobbvist Registration Form 32708. PRINCIPAL IDENTIFICATION: [~ Produced ID ~a.~'p~ ~~" rf VP/J L{~L~HJ'~ Form of Identification ^ Personally known (Principal) ~ ~ ~ c z RS ~-~ N Y-~rr. b M' ~U ~• ~q°~ ° w a~ ~ State of Florida, County of Miami-Dade Swor and subs a ed b f z ? ~ o e ore me p Thi , ' s day of I , 200 R, .~ ~ FL ~ v s: ~ ~ G ~ a Si ature of Public otar State of Flo it d ~' Notarization of Principal's signature Q' o V rl FRIC'C I ICF (1N1 Y _ I_ ~ _ o •; P ~ ~''~~~"~`'~ m~ 03/27/2008 ~a~~ `V ' - 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ~ a~ ` 1 City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.AOv CITY CLERK office CityClerk(a~miamibeachfl.gov Tel: 305.673.7411, Fax: 305.673.7254 LOBBYIST NAME: Mohsin 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 for lobby t withdrawal in writing. °I ~' ! ©°I Signature: Date: MIADOCS 3621764 1