John Bosch - Ameresco Inc.m MIAMIBEACH A"'`S~~-
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.)
Bosch John
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 jbosch@ameresco.com
LOBBYIST RETAINED BY:
i
y NAME OF PRINCIPAUCLIENT:
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
III. 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) An Financial, Familial or Professional Relationship
Mayor None
Commissioners
City Administration; City Attorney's Office; None
Cit Committees; Cit Boards
~~.
5
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
On Procurement Issues":
®Yes ^ No: Are you lobbvinq 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 By Lobbyists On
Real Estate Development Issues":
' ^Yes ~ No: Are you lobbvinq on a pending application for a Development Agreement with the Citv or
application for chance of zoning map designation or chance to the Citv's Future Land Use Maps
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 6a No• Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
,.., ,.,.~,...~., , sr ,... ~ . ,... .,~ .
I do solemnly swear that all of the fore
provisions contained in Section 2-482 0
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION
facts are true incorrect and that I have read or am familiar with the
liarpi.~eactyyrity Code and all reporting requirements.
PRINCIPAL IDENTIFICATION:
Produced ID ,DLL p0µ'7 X6/09
~~ Form of Identification
~~ ~ ° Personally known (Lobbyist)
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N~ II. .SIGNATURE AND STAMP OF NOTARY:
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a ~ fate of Florida, County of Miami-Dade
~'€ f worn to and subscrib d before me
,~ ~ his a / day of ~w~y ,2008
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~Signatufe of Public Notary -State of Florida
'Notarization of Lobbyist's signature
TO BE COMPLE
Annual Registration fee: [ Yes [ ] No Amount Paid $
Lobbyist Registration Form received and verified by: _
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CITY CLERK'S USE ONLY _ / ~ , ~ z ,~'••~,,;.~~`'
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