John K. Shubin - Tides Hotel...
m MIAI~~IBE~CH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
`~
eu~
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat or modi0callon of
any ordinance, resolution, acton or decision of any commissioner; any action, decision, recommendation of the CIry Manager or any city board or
committee; or any action, decision or recommendation of any city personnel during the Ome period of the enOre decision-making process on such
action, OeGslon or recommendation that foreseeably will be heard or reviewed by the cky commission, or a city board or committee. The term
spedflcally includes fhe pdncipal as well as any employee engaged !n lobbying activl0es. The term "Lobbyists" has specific exclusions. Please
refer to Ordinance 20043435.
K
. w. t rawt t (
BUSINESS NAME AND ADDRESS (Number and Street) (City) (Sta 33 13n
(Zip Code
3a5- 3$t'-~o~o 'dos-3a t- 4a.s-a Aal....tui~..l~
TELEPHONE NUMBER: FAX NUMBER: EMA .
s~...e~~ b, ~ ~ ,
I. LOBBYIST RETAINED BY: -T'H ~ Tl b ~ ~ H \1'T G t__. /
~ a c. i `' `~`"..
t ~""~ u T L L. rLU P <w"'T'~r ~~~'
.-~- ti, Q ~t-~
(Last)
zzo C] L2 ow. D n.~ u ~t ~ r ~'l.. 33 X39
~INESS NAME AND ADDRESS (Number and SVeetl ICitvl tch,rat n.., c,.,rei
" G. C1 T ~
a
or
• 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 ~PE:GIh71C~L~OBBY~S~lJE Po t q `~
~ d B r a ~ a t v~ tit..r>B t f t a. e`A- t wt -f' o W P '~-'r w,. '-[' tha.. ~ ~ 4 BIZ ,
Issue to be lobbied (DescnTie in detail):
lu ~G.ITsil(~A~EN'GIES'/,IN`~DI~YID,UAL"5 TtO~BEzLOBBIED: Pursuant to city code section z-asz(g) Include
a statement of the extend 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 Seetlon 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 subJed
contractual relation.
A Full Name of Individual Title B An Financial, Familial or Professional Relationship
,:~, ~.
hS ~Z ~!d £Z 83d OIOl!
/s~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
~~ B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
O~n/Procurement Issues°:
^ Yes LvJ No: Are you lobbvina on a present or oendino bid for goods eauiament or services or on a
present or oendino 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 L!~ No: Are you lobbvina on a oendino application for a Development Agreement with the Ciri or
application for change of zoning map designation or chance to the Citv'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 ariot-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.
reimbursement. .
~PPoduc~ed Iv S15o•~i7/•6/- 3$1-b
Form of Identification
R
~' `=
w ~
^ Personally known (Lobbyist)
s VII. SIGNATURE AND STAMP OF NOTARY:
~
s
~ ~
State of Florida, Count of Miami-D
Y ode
_W-. Sworn to and subscribed b.?ef~ore me ~p~
This _.p??Z_day of FAG. _2p~
Signature of Public Notary -State of
Notarization of Lobbyist's sianatw
V. SIGNATURE UNDER OATH:
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 Miami Beach City Code and all reporting requirements.
Signature of Lobbyist: \T
Signature of PrincipaUClient: ~ i'U'
VI. LOBBYIST IDENTI CATION:
bNCsR.AL.. MANA Ls,e•
K~_TiP~a° beta t~cN
Produced ID ~J°-~oSaa`~~ /C~rlt~o~N/k~L
Form of Identification a-*_•~+1e..w..
^ Personally known (Principal)
g~~
State of Florida, County of Miami-Dade ~ +~~
Sworn and subscribed Before me ~p ~¢~
This ~d~aynof p b_ ~ ~W(t~R-t 2000' ~
Sig ture of Public Notary -State of Florida ?~ I
Notarization of Principal's signature ~
Annual;Registration fee: ;[ ~] Yes:[ ]:No 'Amount P
lobbyist'Registration.Form received and verified bv:
~~ ~ ~~
Signature of Lobbyist
Ciy of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fax: 305.673.7254
CityClerk@m iamibeachfl. gov
LOBBYIST NAME: -~..~ n rr-t ~, ~ . ~ ..~. ~... [~ ~ t"
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 amirequired
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
~~
Signature:
Z,/Z3f 1 v
Date:
F:ICLERILOBBYIST1Lobbyist Registration Form 32708.doc