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Paul M. Steinberg - 55 La Gorce Circlet _ ~ (7fUf ~L ' ~ City of Miami Beach Office of the City Clerk _ ~ 1`700 Convention Center Drive, Miami Beach, FL 33139 - LOBBYIST REGISTRATION FORM ' r Lobbyist means all persons employed or retained;,whethergaid or not, by a principal who seeks to encourage the passage, defeat or modification of any ordinance, resolution, action or decision' of any wmmissioner; any action; decision, recommendation of the City Manager or any city board or committee; br any action, decision or recommendation of any city personneF 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 lobb 'rig activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.. NAMEOF LOBBYIST: Last) (First • . - ~ 'BUSINESS`NAME AND ADDRESS ` (Number and Street) (City) (State) (Zip Code) .. , ' ~~vl ) S?, ~---~-3~'~-~ ~3u~) 3~f-~3~-0~}'1 ~ ~~3s~~c~9~ 1~/• cep T~LEPHO NUMBER: FAX UMBER: EMAIL: . . I. LOBBYIST RETAINED BY: .-~ ,_ NAME OF PRINCIPAUCLIENT: BUSINE .NAME AND ADDRESS Number and Street) (City) (State) (Zip Code) ~ s1 lc~ 1--~~- h ` : t TELEPH NE NUIGIBER: FAX NUMBER: (Optional) ~ EMAIL: (Optional) ` n.SPECIFIC .LOBBY ISSUE: ~ U~P ~. " : ~ ~ mac. t rM.c ~ . ~ / /`~ .S (~ I 1 C1 ~ w [-rZ. ~ ~'t/l-J ~ , S 5 ~ i %1- '• Issue to be lobbied (Describe in detail): - In. :CITYAGE~ICIE$/INDIVI®UALS TO BE LOBBIED.,: Pursuant to city code section 2-asz(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. IV. ~ DISCLOSURE OFTERMS AND AMOUNTS OF LOBBYIST COMPENSATION,(DISCLOSE WHETHER HOURLY, FLAT . RATE OR OTHER):' , A) LOBBYI T~ICS~CLQ URE: (Requir d) ~" B) PRINCIPAL'S D S LOSU E(~O,F~ L-OBBYIST COMPENSATION): (Required). ~~ ~.w~ ~~ S~ Do The following information must be answered: ~• 4). ' Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists ' - Orr Procurement Issues": . ~. ^ .Yes ~NO: Are you lobbying on a present or pending bid for goods.. equipment or services or on a - '.., present or ciending-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": ` 3) . Pursuart to Miami Beach City Code 2-484 (h)'Any person .(except those exempt from the. definition of ' "lobbyist'` asset 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 `~NOE Are you reple'senting_a .not-for-profit corporation or entity without special compensation or reimbursement. , . ~ -° , V. SIGNATURE UNDER OATH: ' ' I do solemn)y 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 2-4~,i2..e a Mia ~ eac ` i "Code and all reportin r ments. " _ Sig""nature of Lobbyist: ~'~ ' Signature•of Principal/Client: (/" ~~ NOTARY PUBLIC-ATE OF ~B~t11ST IDENTIFICA ON: PRINCIPAL IDENTIFICATION: ,,, ,, Beth Barash. ~~,, :Commission ~~ 252 p'••, ,.,. Expires: J~§;~b~gd ID 0 .Produced ID sorrDEpTxavnT,~,ntyziosormgreco:,rxc: Form of Identification Form of Identification ,~/ NOTARY PUBLICSTATE OF FIATUO Personally known (Lobbyist) ~ . 1~ Personally known (Principal) Bed ~~'~h ~~'_Commission #D~-786252 *VII'. SIGNATURE AND STAMP OF NOTARY: ,, Expires: 3[TIyE 24, 2©) " ATLAN'rjCB DING 0. IIiC. ' ,,~~rmEn'rxnU ° c BO ~I~" . State of Florida,. County of Miami-Dade State of Florida, County of Miami-Dade Sworn to and subscribed-t~ re me Sworn a d sutiscrib efore me This ~ 2 Z day of J'_, 20¢9 This 7-~ day of 09 f~~ Signature of Public Notary -State of Florida Signature of Public Notary -State ofFlorida .Notarization of Lobbyist's signature . Notarization of Principal's signature - City of Miami Beach, 1700 Convention Center Drive, Miami Beach,. Florida 33139, vaww.miamibeachfl:gov ' ~ CITY CLERK Office CityClerk@miamibeachfl.gov Te1:.305.673.741 1 ,Fax; 305.673.7254- P~~.~. - • . LOBBYIST NAME: ~~ ~ ~~ ' ~ ~ I understand that no later than October .1st of .each year,. 'I must file the following ` ~ forms,: pursuant to Section 2-4$5. of the .Miami Beach. City Code, with the City Clerk's - ` Office #or 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 immmediately notify the City Clerk's: Office of lobbyist withdrawal in writing. - Date: