Ilija Mosscrop/Joshua Gurwitz~ i
s.~.
1
BEACH
City of Miami Beach Office of the City Clerk ZD1Q ~~~,~ ~~
1700 Convention Center Drive, Miami Beach, FL 33139 ~~ ~l ~ 34
,•
LOBBYIST REGISTRATION FORM ~~ ~, ~ ~ L. ~ Fe'{-4' `V r ~ ,
~ f' t' ~ (, N
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 board 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.
~` o9SS~-hP ~~I JAr
NAME OF LOBBYIST: (Last) (First) F,,,, t^~ j M.
~''taSS~ ;ASSa~!/~f~S °t4~ u.~ca~, ~~ ~ 3zS r~ 33~~~~
BUSINESS NAME AND ADDRESS (Number and Street)
3oS • s34-•~-~~g. 305.53.4-•qaz~
NUMBER: FAX
I. LOBBYIST RETAINED BY:
~~65 N ~A GuK.w~ r Z
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)j
• 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:
(State) (Zip Code)
:EL~.Sovt'N .c-~FT
NAME OF PRINCIPAUCLIENT: 711 M1e.~ dw t,., a v~ ~
3tg~ a•Y~.. PA~lrt ~v~ ~~~ cy~At+~-+ ~e~1-~u~ Ft... 33 ! ~-o
BUSINESS NAME AND ADDRESS ( umber and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
X11? • 3~0 =7602-
n SPECIFIC LOBBY ISS;,UE ~~ ~,r ~~ Z SE T~~ S~7 / ( O
31°13 R~YA1. P/K.r1 Ryrc . ' V A R la.~ r-~'S ~1~- S w1 ir-t11.~ G ~ P°GL A-T .4
Issue to be lobbied (Describe m detail). S I ~ G ~ _ C~ j„11 ~~ ~ -,~„ f n ~~ ~_
nl. CITY.AGENCIES%INDNI®UALS T07 BE L_~BBIEDI: Pursuant to CityCo~de~SecYtion 2-482(g) include
a statement of the extent of any business, financial, famiital, 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' commencemerit of service with the City to the present date, stating the general nature of the subject
contractual relation. ,
A Full Name of Individual Title B) Any Financial, Familial or Professional Relationshio
~~tLp ~ ~ ~rDwyT r~ ~T ~ o ~ c
S~
iV. - DISCLOSURE OF TERMS AND AMOUM1(TS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
• RATE OR OTHER):
... A) LOBBYIST DISCLOSURE (Regtired). .. •
_ (~Ooo
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): .. ~ •
(Required). ~~~GOO -- .
' 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 ~O: Are you IobbVing on a present or pending bid for goods equipment or services or on a
present or pend~ng-award for goods equipment or services
• 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
' Real Estate Development Issues":.
^ Yes ~Na Are you lobbying~on a pendind application for a Developmerit Agreement with the Citv or
application for change of zon~ng map designation or change 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 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
sectioh but, shall not be required to pay any registration fees. ''
• e~~ Yes ~NO' Are you representinn a not for profit corporation or entity without special compensation or
• - reimbursement... •
` ,. V. SIGNATURE UNDER OATH:
ON•DCTOBER 75T 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 EXPENDITUR S OR COMPENSATION DURING THE REPORTING
.PERIOD.
~~
ignatur of Lobbyist
I do solemnly swear that all of the foregoirig facts are true and Corr t 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; •
o ~ Signature of Prihcipal/Client: 1 /t/1/l .
~n°°~~ '
N c VI. LOBBYIST ID
ENTIFICATION:. r / o
a o ~~ e . v PRINCIPAL IDENTIFICATION: _
a€. .Produced ID ibf~(~/-~~~ti ~ -,~,~ ~ ~~Protiuced ID ~ ~3 Z. ~ `T Z`~'' 7
~ Form of Identification ~ ~ ~
~ Form of Identification
~~g
. ~a~ doh ^ Personally known {Lobbyist) Personally known (P.rincipal} _ ~
~_ ~ ~ '
^, ~
'~~, e~ ~ VII.. SIGNATURE AND STAMP OF NOTARY:. - ~'
~~~~ I ..
.~.,i~:i:..{ x
State of Florida, County of Miami-Dade State of Flori , C unty iami-D e ~
Sworn to and subscribed~befor me Sworn an ubsc bed efo a me ~~NT~'•.,
4 , This .~3 _day of ~ ~~- .~ } ~ , ~~'.. -•dr,.
gnature oyPubRc Notary-State of Florida Signa re ub o lorida ~~`"""¢~~
' Notarization of Lobbyist's signature Notariz Principal's signature ~ ,
• 'TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual•Registration'~fee:.`[ ;] Yes;[:; •].No. 'sAmount'Paid::$. •-- MCRa#. O Date'Paid ..
Lobbyist Registration` Form received and ver•ified.tiy:
F.:}GLER\SALL\aFORMS\L086YIST.FORMS\Lobbyist'Registration Form 211Q9cdoc
:Revised 02[.11/ 009
1
~~ ~ ~ I ~ ;.
City of Miami Beath, 1700 Convention Center Drive, Mipmi Beach, Florido 33139, www.miamibeachfl.gov
CITY CLERK Office
' Tel: 305.673.7411 ,Fax: 305.673.7254
CityClerk@miamibeachfl.gov
LOBBYIST NAME: ~ ~'.~J A' NI4 S 5 L~' Q
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.
l) 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 of lobbyist withdrawal in writing.
~-. 23 • t o
Date:
F:ICLER\LQBBYIST\Lobbyist Registration Form 32708.doc