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Neisen Kasdin/Marshall Berkson,~ . ~x-'r. -.: ~ . _ ~1%` City of Miami Beach Office of the City Clerk 1700 Convention Center .Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM --- -- -r~~--.- -~ , -~:_~ .__ ;n/ f~~gdL~~ = - Ff~ 5 f©~i ` t~rEQ~~9- . ,b~3f~~c Lobbyist means all persons employed or retained, whether paid or nof, 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. ~~s~4~v rve~s~n D . NAME OF LOBBYIST: ~Kl/ irrlrl' f ~rn~~~~ BUSINESS NAME AND ADDRESS TELEPHONE NUMBER:" I. LOBBYIST RETAINED BY: NAME OF PRINCIPAL/CLIENT: BUSINESS NAME AND ADDRESS TELEPHONE NUMBER: ~ (First) (M.I) ...1- ~.~ 311 pvQ .. 25~, ~i. ~t~;. ~-- 3,~;± 3 r (Number and Street) (City) (State) ~ ip C ~ ,.ADS 3~ y- ~~S 1'~i SPn .14A~.~In f4l~,Prrr~l FAX NUMBER: , EMAIL: l P~U~n ~~~ M c~rw~ 1~P~-l Ft_.. 33~13~ ~m~ Str~~ I _ ~C~ty),,, ~ (State) (ip Code) FAX NUMBER: (Optionaq EMAIL: (Optionaq Fill out this section if,principal is a Corporation, Partnership or Trust [Section 2-482 (c)] • 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.S'PECIFIC LOBBY.ISSUE: iC OVQ~I~.1 i71STfl Issue to be lobbied (Describe in detail): Ill. CITY AGENCIES/INDIVIDIJALS TO BE LOBBIED: Pursuant to city code section 2-48z(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. A Full Name of Individual Title B) Any Financial, Familial or Professional Relationship l A~nn~] n n Oi- W £o .5 ~ L7 ~~~~ n~oz 5'~ ., , . . . com 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 (Required). 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 lobbving 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 Miarni.Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^ Yes ~ No: Are you lobbving oh a pending application for a Development Agreement with the City or application for change of zoning map designation or change to the Citv's Future Land Use Man? 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 ~NO: Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1sT OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED Signature of Lobbyist: Signature of Principal/Client: VI. .LOBBYIST IDENTIFICATION: ^ Produced ID ,~.,~ form of Ide Ll~' Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOT State of Florida, County of Miami-Dade Sworn, d subscrib before me This day of (~ L , 20~ ~// A Vii. Signature of Public,P~~tary - State,of Florida Notarization of L vist's sianature Annual Regi LobtivisYRe ~~ PRINCIPAL IDENTI FICATIO N: ~ y /G / Produced ID ~JV °~ ~~y'0 c~'~ ~~~ P ~ ~ - s ~ . _ Form of ldentificatioh ~~Ntfll[IIfIHJO~~ yq~F ~ ~~~~~~~~\PM R. r! ~ .- ~ o o~ • ~~~ \~~ ~~ MIS o : F ^ Personally known (Principal) oM Si ~ y,a ' o ~tuarylgaF~AlO ~ ~~~ m * ~ e - a~ E H R,:~ ~~ :a ~p; ~0 o c State of Florida, County of Miami-Dade 91• ~d ~ d3p36I :• *` z.~~ ~ w Sworn•and subscribed b~f re me / [~$i"OG ~:~ba~e~dQ1wi~~;;•' ~~~ Y~o `\~?~~ This ~~day of . 20r~ //~~i~i /~ TATE 0, ~ ' ' ~;,~" Si nature of Public Notar 9 y - ate of Florida Notarization of Principal's signature / TO BE COMPLET ion fee: [~ ]Yes [ ] No Amount ~tion' Form received and verified. by: D BY CITY -~~ • ~~ ~rrr.. t i:I~3: S STAFF ONLY I~ D MCR #- O =35 -Date~'Pad . ' // I do solemnly swear that all of the fpr~J$bi~g facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-4~/~~~t Miami Beach City Code and all reporting requirements. ~ £ ~ r~ A °~ ~ j City of Miami Beath, 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: I V ~~ J ~ ~' ~~n ~~) 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. ~ a~-I-o Signature: Date: iraCL.~¥~1L.C~C3F3YiSTOLot~b~i~t F~€sgistration ~orrn 327CI8.cdo€;