Robert L. Switkes - Yvette Akman. -
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• City of Miami Beach Office of the. City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139• •
' ~ LOBBYIST REGISTRATION FORM
.- ~ Lobbyist mean's alt persons employed or retained, whether paid or not, by a principal who-seeks to enpourage the passage, defeat or modification of ~ '
`' any ordinance, resoliatidn,.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. '
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NAME OF LOBBYIST; (Last). • ~ (First) (M.I) '
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BUSINESS NAME AND ADDRESS (Number and Street) . (City) (State) " (Zip Code)
_ w TELEPHONE NUMBER: ' FAX NUMBER: EMAIL: `. ~~
~' '`LOBBYIST RETAINED BY:' -
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' ~ .,
,' '. - : '.• :NAME'OF`PRINCIPAL/CLIENT: r
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', ~_: B S_~ NAM~E~ND ADDRESS (Number and Street) ..(City) . (State),. ~ (Zip Code)
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TELEPHO E NUMBER:. FAX NUMBER: (Optional) _ EMAIL: (Optional) „•
II;~I''Cl+'It'Ll. LVtStST IJ~UC: ~ _ - _ . ~ -: J ,
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;issue to be lobbied: (Describe in detail):.
nl: CITY AGENCIES/ItVDIVI,®UALS: TO BE.LOBBfED: (Pursuant to city:.code section 2-as2(g)"
. include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise town
,;~ appearance,of'an. impropriety, with any City persohnel 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 the
• .commencement of service of City personnel to be-lobbied.) , `
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IV. ~ DISCLOSURE DF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
" ~ RATE OR OTHER):
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` ~ ~" A) LOBBYIST. DISCLOSURE: (Required)
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~, B) PRINCIPAL'S DISCLOSURE (OF ~ YIST COMP TION):
' (Required)
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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";
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• 'Yes ~ ^ No: Are you lobbying on a present or pending bid for goods equipment or services or on a '
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,. '. presenfor pending award for goods, equipmerlYor service?
,~ 2) :'°~. ;Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions-By Lobbyists On , -
` ,R~,e/al Estate Development Issues": '
' ^ Yes ` IiQ No: Arewou lobbying on a pending application for a Development Agreement with the Citv or '
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.' application for change of zoning map designation or change to the City's Future Land Use
n 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 No: Are ou re resentin a not-for- rofit cor oration or enti withouts ecial com ensation or
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' "' reimbursement. .
" : ~~.` V. SIGNATURE,UNDEROATH:
. ~ I do solemnly swear that all of the foregoing~ct' are true a correct and' that I have read or am familiar with the..'
;,,. - rovisions contained in Section 2-482 oft ~- ~a i Beac ity Co and all reporting requirements. + '' . -`
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'Signature'of Lobbyist: -~ = '
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Signature.of Principal/Client: ,
' .'VI. •.LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
-`- ^,'Prod•uced ID ~ ^ Produced.ID
{ '> `' ~ Form of Identification 'Form of Identification '
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L1,~ Personally known (Lobbyist) Personally known(Principal)
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• • ~ : > -_. VII. SIGNATURE AND STAMP-OF NOTARY: '
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State of'Flonda, County of MialY~i-Dad LAURA CANO t~of Florida, County of Miami-Dade
.~ Sworn~Q' a~ad subscribed beforeUm N` ~~ Ccmrtd~ DD0747~ -
• , s ,tA *~ wo and subscribed before me -~^,
~° This olU day of ~. = •i± F~Ires1/13/20'1~is dayof~~(1°~n..~S~.'......u.^~.^u^a^~..0......^....^..
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~~ DD0747842
Signature of Public Notary -State of Florida Signature of Public Notary ~; . ~ ida ~plres 1/13/2012
Notarization of LobbvisYs signature Notarization of Principal s si • ~ ~ ~
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' ~ TO BE COMPLETED BY CITY CLERK'S STAFF ONLY „~.nne+~enn.n+ nsnenonnn ^.^^n^^^^^^~^^^°~
Annual.Registration fee. ]Yes ( ] No Amount Pa' $ ' MCR #' ~ Date Paid
Lobbyist Registration Form received. and verified by;
_ - Revised 03/27/2008