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Lee Brian Schrager (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 encourege the passage, defeat or modification of any ordinance, resolution, action or decision of any commissioner, any action, decision, recommendation of the Cily Manager or any city board or committee; or any action, decision w rewmmendation 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 speeifle exclusions. Please refer to Ordinance 2004-3435. ~ ~nrPi1~,P~e/ ~ p~ t ~11~:/~ Il! NAME OF LOBBYIST: I"~?CtOf'1 ,trt'tEfZ.tvltTt~V~t (Zip Code) 3t~ ~ZS ~kr~i ,L I~ 3~ t~24~ I+~oZ I~eSC.h~aAe~®So.~N~evnw~~e . TELEPHONE NUMBER: FAX NUMBER:_ EMAIL: C ori~ LOBBYIST RETAINED BY: • ~2LDIA iN'CE~L{yPr'Ct.'2t~1- U~S1~~S~T~ NAME OF PRINCIPAL/CLIENT: USINESS NAME AND ADDRESS (Number and Street) (City) (State} (Zip Code) TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fitl 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: u.SPECIFIC LOBBY ISSUE:; ~~ ~lPx~a9 I~~~ ..won,-~ ~~r~.~~ ~ vast .a~.~'or~ ~~+-~r~~~s~- Issue to be to bled Descnbe in detail): ~A,~o,~,~ s,,, ~- ul.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 Na me of Individual Title B An Financial, Familial or Professional Relationship r~ (~Ili+vtl ©~fi~ ~0~0=OQ ~ L'o1VV~t0~ ~~~ /P 5 DIV... ~ DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): w ~ A) LOBBYIST DISCLOSURE: (Required) B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): 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 t!~'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-Bylobbyists On Real Estate Development Issues": ^ Yes L~l 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 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. III Yes ^ No: Are. you re resenting anot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE-UNDER OATH: • ON OCTOBER 1sT OF EACH YEAR. EACH LOBBYIS' STATEMENT UNDER OATH. LISTING LOBBYING RECEIVED. IN THE CITaf OF MIAMI BEACH FOR THE PF BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITI PERIOD. I do solemnly swear that all of the foregoing facts are true provisions contained in Section 2 82 of the Miami eh'C Signature of Lobbyist: of Lobbyist ~ect and that I have read or am familiar with the and all reporting requirements. Signature of Principal/Client: ~•~ ~~~ ~-~~z ~~~~ Z u~m ~°,~~ ~ ~a o ~' O ~ o °. N V m PRINCIPAL IDENTIFICATION: ~ Produced ID Form of Identification Personally known (Principal) State of Florida, County of Miami-Dade Swor a d subscribp~~e re me da`y of,^LJ,~1~( . 200~9n KDo , \ r ` . \~~ Y~Ll~ Signature of Public Notary -State of Flori Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual`Registration fee: es [ ] No AmouM'Pai $ ~- NjCR~ Date Paid / Lobbyis4 Registration F rm received and verified by: =--~ y'L-' F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\LObbyist Registration Form 21109.dot Revised 02/11/2009 Form of Identification Personally known (Lobbyist) SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to d subscribe~i,befpre me 7,Hf5~~ day of ~, 2009 '~ " - "' ~ Notarization of Lobbyist's signature r 'm MIAMIBEACH • City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachil.gov CITY CLERK Office Tel: 305.673.7411 ,Fax: 305.673.7254 CityClerk@miami beachfl.gov LOBBYIST NAME: LELC ,DQf+4r~ ~c~~-~tUtiR. I understand that no later than October 1st of each year, I must file the following forms, pursuant to Section_2-5 of the Miami Beach City Code; with the .C-i.ty 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 Commissl~xt on Ethics and for code-~~olation 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. In ~ D Signatur Date: F:ICLERILQBBYfSTILobbyist Registration Form 32708.dac