Ilija Mosscrop/Joshua Gurwitz (2)rf1...
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City of Miami Beach Office of the City Clerk ZOfO APR
1700 Convention Center Drive, Miami Beach, FL 33139 z~ Afii'~: ~~
LOBBYIST REGISTRATION FORM ~'~~ t~ ~ L~<~~ ~O^ ()~: ~~~.~.
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 pdncipal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please
refer to Ordinance 2004-3435.
M o SS c.(~.c 1' 1 c-t~ A
NAME OF LOBBYIST: (Last) (First) (M.I)
t`'1oSS~~ A{Sd4AT~5 `t'+° ~~,~cpl....r hq ~3ZS MlAn1 BrA~t T~ 3~313~
BUSINESS NAME AND ADDRESS (Number and Street) (Cit
y) (State) (Zip.Code)
3o S • 5 3 ~ • °I1 l °I 3 o S • S 34- • `t°117 l ~. f.1 ~ ~ ELLS«~ . c-1 E' T
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
JoSN~A G~Rw~rZ
NAME OF PRINCIPAUCLIENT: ~~ ~2 R ~,,,~~ ~~~ ~~~..
1 ~ 3 (~YA1- P~.Nt Ar vE , L~ C r~~~M ~ d E.4ua ~ ~ 3 t ~
BUSINESS NAME AND ADDR SS (Numbe and Street} (City) (State) (Zip.Code)
TELEPHONE NUMBER. FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (cjj
• 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:
n.SPECvIFIC LOBBY ISSUE';. S ~7l ~ o
~~ ~ tk ~ f^I IV
Miles ~ ~
Issue to be lobbied (Describe in detail): '3 ~9 ~ ~~- ~~,,,~ ~V+~ ~ ~ ~ ~ • 3 '~ ~ ~.. 6
-u. CITY~~i4GENCIES/,INDIVIDUALS T.O B'E LOBBIED.: Pursuant to"City code section 2-4s2(g) include
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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 Clty 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 Name of Individual Title B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTNER):
A) LOBBYIST DISCLOSURE: (Required) •+
(10 00--
;.
v B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). X000"
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 ISd' No: Are you lobbvinq on a pending application for a Development Agreement with the City or
apphcabon for change of zoning map designation or chahge 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 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.
^ Yes Flo: Are you representing snot-for-profit corporation or entity without sriecial compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YE
I do solemnly swear that all of the foregoing facts are true and corr~ct 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:
Signature of Principal/Client: ~(/Q( /`~(/,
VI. LOBBYIST IDENTIFICATION: v
_ ` d ~'~~llL,~
~ ~ ~ ~~oduced ID /''/~ /-(<~1 ~s7a -ASS-v
o ~ ~ Form of Identification
4 a na
"' ~ a ~ ^ Personally known (Lobbyist)
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v ~~ ,VII. SIGNATURE AND STAMP OF NOTARY:
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State of Florida, County of Miami-Dade
~`~;~. 5worn to and subscribed, b~ef~r~. me zo~b
~_ This o7~ day of ~~/ , 2489.
Signat e of publicNotary -State of Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
a PTr tl ce~ID ~Z ,c~L~,7g-
Form of Identification
Personally known (Principal)
State of Florida, oun of iami Dad
Sw subscribed bef rem ~,"
T is I17 ~f ~~ J n nn
Signatu
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TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
AnnuakRegistration fee ~[ ' Yes:[, ] No, ~.Amount?Paid$ MCR:# / a
'Lobbyist=`Registration Form r•ecewed and:verifiedai fDate~P,aid ; .
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'F:\CLER~SAL'L\aFORMS\LOSFlYISTFORMS\LobbyistRegistrationFnrm:211Q9.doc ,~..n~r _ 97. ~~ :;oo..:~..a•.,~.,, ~-..,....
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk@miamibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: ~ ~'~~ A rM~'S S C"~'O P
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.
]) 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..
Signature:
Date:
F:ICLER\L08BYIST1Lobbyist Registration Form 32708.c1oc