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Jeffrey S. Bass - Il Villaggio Jesse Carvajal._ -r` ~ ~',~ its (~ (~.e;latrn4 .~,,;,~,a.c~- (~~ F~C~I, v--w~ - ~. . , ~, .. .. Cify of Miami Beach Office of the City Clerk' ~~ - ~ - ~ 17,00 Convention Centel- Drive, Miami Beach, FL 33139. T LOBBYIST REGISTRATION FORM _ _ totibyist.means all .persons employed' or retained, whether paid or not,:by a principal who seeks to encourage the passage, defeat or modification of - - any.prdinance;'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, oc a city board or committee. -.The term - ;specifically includes the principal as well as any employee engaged in lobbying activities: The.term "Lobbyists" hasspecific exclusions.. Please refer to Ordinance 20043435. `" - ~- . - ,NAME OF LOBBYIST: (Last) first) ~ (M-~I) ~' ~'""''" ,. - ~ ..4 ~ n. . ~ ~(.~ ~Q Iti ~- S ~ . .., ~D G •(.n~ . l sf- "~~.e~ I'lAd Q rum + . ~ ~J:~~ . ` BUSINESS NAME AND ADDRESS (Number and Streef) ( ity) ~ (State) ' ~-~; :(~l~p?Code)t ~ , - '~: ~,.- ~~ ,. '' .: .. ~, ' TELEPHONE NUMBER: •' fAX NUMBER:. EMAIL: :: 4 `' sl ,w-°a , _ -- , N L. LOBBYIST-RETAINED BY: • --,-~ U a i ',-, ~ ' ,NAME OF PRINCIPAL/CLIENT: - , ! ~: w~ O a ~ T c7 _ • :~ _ . V. ~~ Qua n:Dr ~. 1~.~-cat nip-~eac~ . PL ~33i3~I BUSINESS NA E ~ R~~ ~ ~ (Niambersnd-Street) City (State)" (Zip Code) Q~ ^,~ : • TELEPHONE NUMBER: ~ FAX NUMBER: (Optional) `~ "EMAIL: tionaO - ~ u.SPECIFIC LOBBY ISSUE: - .~•_ ~ ,, _ o ... _ ~h`cYL ~D N~- A Inbthlncmca~l ~~~c-~ Isla i ~rn~e ' ~ ~ Issua,to be lobbied (Describe in ail): ,. :: .. ~. .~ ' lil. CITY AGENCIES/INDIVIDIUALS TO BE LOB$1ED: Pursuant to City Code Section 2-482(g) include _ .: _ ~ , ` "° , a statement~.of the extent of any business, financial, familial,' professional or other relationship, giving rise to an ' . - appearance of am impropriety with any .City personneP sought to be lobbied.-- further, `pursuant to City Code Section 2- - 482(a)(4) include' a statement of any rontractuaF 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. Name of Individual Title B) Any'Financial, Familial or Professional Relationship ,. -; .,.r • , 4 - ,. ,., - •. , :' i. _ - .- ,, .:~ . ' ~ ~I'V.,, -DESCI:OSIJRE O,F 7Ei2M3;A;N[) AMQUhITS C3F.<:OBBIfIST°C(3MPEf~ESA'fl,Otd;tDISCLOSE;WFtETtiER~Hduft~Y; fLAr' . , ,. - RATE OR'¢TNFRJ. ~ , : , , "` y A} L068YIST D18Ct,OSURE~ (Required)- _ ~~ ~ -C7t~ u ~Yy,-~s~s ~. ` ', • B) .PRINCIPAL'S DISCLOSURE,(O~ LOBBYIST COMPENSATIOVj: ~ ,. . (Required): + ` 1`he following lnformatioh mustbe answered;: ~ ' ,. - .1) Pursuanf;fo M1amI Beac)i Gty:CoBe Section 2-d88.;Entjtled °Prohibited Campaign Gontntutions By Lobbytsts° ` ~- ~ ', ~ :Qn Procurement~i`ssues°~~ W. ~- ^ Yes . Q~~o:.°Are:VOU lobbyinct°an,a presenf or pending bid for.goods eauipm©nt`or services "a"r on a° ' present or:'pending avrard~for sfoodsa equipment o"r-service?, , ... ,: _ Real Estt,to.Miarni l3each Ctty Code 2 49a`~Entitled Prahitfted Campaign Contributions By Lobbyists On; 2 Pursuan ~,,,..~., - ~ ~ate~Developrnant Issues" - ' a .3) Pursuart`I to Mtarrrr 8eacti City Code 2=48Q (h) -Any person (except those ezenpt frori the defriition 'of= "lobbyrsl" asAsef. forth in Scc-ion- 2-481 ,above) "woo only appears as ;a Fepreseritative of ~ nof=for-profit ' corpar'a{ion or.eniily yrithout special compensation or reimbursement fvr the,appe2rance, wi~ethet direct,, or - indirect, •to express' support of or opposition to any Item; shall regrster ~4ilh the ~cterk as ~reguired by this. sechontiut, snail not be-required;to pay any_ registratian`fees; ,~,/ Yes W No .Are you.representtn_y~a not.for=prof't "or ~oratlon or~entlty without'special com~e~isatlon or _... K reimbursemenf:_'. _ Vc SIGNA7URE4UFlDER,DATH: C)N OCTOBER`;15T OF' EACH YEAR; ~EACN LOBBYIST SHALL SU~BMIi' TO' `THE-CITY CLERIC A'SIGNED _ ' . ,$ A EMENT .UNDER OATH ...LISTING' LQBBYING_ E t] U S AS' .WELL' ~COMP,ENSATION' " ` ` RECEIVED IN"TME•C1TY'©F MIAMLBEACH FOR THE% .RECEDING CALENDAR`~Y 41~?'' ,8T.a4`fi;MENT SHALL. BEFILED.E E .IF-TNERE~HAVE BEEN NO EXPE ITURESORC MPE S~ D' R G~'THE°"REPORTING: "PERIOD: °. ... .,> ._ _ .. A +~j ,.. ,~, - /y J •,. , ~ ~ ~ ~._ -~ ` _m ~ ~`i ~' ignatu of C~st~` .. . ~. _ Iado solemnly wear iltat all f the fare_ goi aet : ~ true~tand r ct and that I 'have read or am>famlliar"with •ihei ~. ,... provtsians con fined in Sec o ~~~ h ', 'City Cb eland all reporting requirements., ' . y~~ -_ ..~t = . ~~ ,. ~, ~ . - Signatie of Lob[iylst .: ' .. ,., ": a ; , 4 t . ., , ,. _ w - ' ~ . . `Signature of PriricipaUClierit ; ......., - - f ' • ~ VI'. .LOBBYIST IDENTIFICATIONi: PRINCIPAt;:IDENTLF,ICATIO;N, ~y"1. ' a~ ~ i b` i}. ~;Produced;ED ~_, ....... ^Pr•oduc,rtllp.... _ ...._- ,. - i - ~ ":Form of Identification. Foam of,tdentification . ~ . ~ k f , Personally knoivn~(Lobbylst) Persdrially.kriown:(Prtnclpal} ~, ' _, ~ ~: ~~ VII :SIGNATURE At~tD SIAM.P t~F. NOTARY,; ~ • :. .. ~ b.`~ .,.. , ~S o . y Svaoen t Fa~ rdsufjscnbed before m ade~ State of Floc dba Couniy of Miami Datle ` ,,. ., ~ ~ Sworn.and` u scnii'e 1 before me;. This .daysof ~vd~;,`-2t)@® This ~_day of A YC~1/~ : 20ff9 . ~ ,, ~,. ~~ fl~~r v b~t.~ne~e~o ~ . ~ - Signalure~af Public Notary ~ ~ ~'lo +, y Ilc ~ 51eto of Flor~~ ature of feu tc~otary `St t ~ ''.'~ , ' Nbtarrzaton ofLobb tst' •~~ g ~ ~ ~ nzation,of Principal's sl attire , y~~`- ' f.+y_GOf+iRI.,~Np1rA6Q"Ct~ 2~~' ,. - ~ ~ <>~v~ ~~ C~nnortlsslon fi 4D 3~f7313 ~ _ ~ - _ rr ~Qii X~-EL+~r~1J't.'~u~~ <'S STAFF Annual Re +stration feo: r "~ ~ -r~~~~ g~ 3~•~._~~..3 ~..-:"+~.,~~:s~: Icy .. PACR tt Date Paid Lobbyist Registration For+n received and veriflod by: - ~ . ~ _ ' ~ f~ICL[rt1YALLeat~q[th551LOt1t3Y15TF,ORt~9&~~LolSbyistReAistra n`r~rro F4 oc, <:-. OZevised02/11~/2009,:';~,.; .;; ~ ' i-, __ .._ -City of AAiami Beach, 1 Z00 Convention Center Drcive, Miami Beach, Flori da 33139; www.miamibeachfl.gov CITY CLERK Office - - CityClerk@miamibeachfl:gov Tel: 305.6731741 T ,'fax:~305.673J254 . -` , LOBBYIST NAME:. ~• ~ - ~- .~°. - - I understand.. that no later than October.:1 st of each year.,. I must. file the.. following. - forms, ~pursu'ant -to Section 2-485 of the Miami .Beach City Code, with the -City Clerk's . ~ ~, Office for all active lobbying ~NSSUes. ; # ~. 1) Lobbyist Expenditure F<~rm ~ . 2)- Disclosure Form Failure to ;file these forms on;a timely basis will result in my name being. transmitted to the . IVliami-D.ade:'County Commission on Ethics and for code violation evaluation. `- In~addition,~once an issue 1 ht~ve'r-egistered to lobby on has been resolved,,L am required - ~ ~ : to immedia otify the City Clerk`s Office of_lobbyist withdrawal in writing. . . , / ~'