Jarrett Nasca/Orange Bowl Committee,~r.';~
m MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
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 speclflc exclusions. Please
refer to Ordinance 20043435.
NAME OF LOBBYIST: (Last) (First) (M.I)
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B SINESS ME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
331(0
305 - 'tF - ~o~l. o
TELEPHONE NUMBER: F NUMBER: EMAIL:
Please notify this oti~ce if your contact information changes: address, phone, ore-mail address.
1. LOBBYIST RETAINED BY:
prinGpal Is a
or Trust
• 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.SPECIFIC LOBBY ISSUE:
Issue to be lobbied (D scribe in detail):
NoN-'PRo~~-rte
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-ao
____ __
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(8) 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 Clty 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
personnel' 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 An Financial, Familial or Professional Relatlonshi
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ~ m-~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST CO/M(P/E(JNSATION): ~ ~y~
(Required). 1 VU 1 l
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":
' - present or cendina award for goods. equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
(R,/eal Estate Development Issues":
^ Yes CLI No: Are you lobbvina on a cendina application for a Development Agreement with the Citv or
application for chance of zoning map designation or chance 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 Gerk 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:
A\I A/'~TA~Cl1 I.ST Ar r ~ ~~ ~ v~
PERIOD.
I do solemnly swear that all of the
provisions contained in Section 2-4_
Signature of Lobbyist:
Signature of Principaf~G~: _~
VI. LOBBYIST IDENTIFICATION:
facts are true ary~orrect and that I have read or am familiar with the
Ijami Beach City Code and all reporting requirements.
^ Produced ID
"'~ Form of Identification
-- Personally known (Lobbyist)
# ~
.. VII. SIGNATURE AND STAMP OF NOTARY:
.~ State of Florida, County of Miami-Dade
3 Swom to and subs ed before me
• T ' day , 2010
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^ Sign ur of Public Notary -State of Florida
Not ti
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~ TO BE COMPLETED BY C
Annual Registration fee: [ ]Yes [ ] No Amount Paid $
_
Lobbyist Registration Form received and verified b
:
y
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification ~
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¢~Personally known (Principal)
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State of Florida, County of Miami-Dade 'V
.~
Sworn and subs ed before me ~ ~
T is ,day of , 2010
y
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S' n ture of ublic Notary -State of Florida
rization of Principal's signature
4 ~Q
:LERK'S STAFF ONLY N~`^~f -~~ ~/ y
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Revised
:.:r
m MIAMIBEACH
Cittr of Miami Beath, 1700 Convention Center Drive, Miami Beoch, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk@miamibeachfl.gov
Tel: 305.673.7411 ,Fax: 305.673.7254
Acknowledgement of fines/suspension from lobbying for failure to
comply with City of Miami Beach lobbying Laws
LOBBYIST NAME: ~~~~1; l ~ ~~ C~~
I understand that no later than October 1st of each year, lobbyists subject to lobbyist
registration requirements shall submit to the city clerk a signed statement under oath
listing all lobbying expenditures, as well as compensation received, for the preceding
calendar year with regard to the specific issue on which the lobbyist has been engaged
to lobby. A statement shall be filed even if there have been no expenditures or
compensation during the reporting period. The statement shall list, in detail, each
expenditure by category, including food and beverage, entertainment, research,
communication, media advertising, publications, travel, lodging and special events.
FAILURE TO TIMELY FILE THE EXPENDITURE AND FEE DISCLOSURE REPORT
WILL RESULT IN A FINE OF $50.00 PER DAY. ANY LOBBYIST WHO FAILS
TO FILE THE REQUIRED EXPENDITURE REPORT BY DECEMBER 1, SHALL
AUTOMATICALLY BE SUSPENDED FROM LOBBYING UNTIL ALL FINES ARE
PAID, UNLESS THE FINE HAS BEEN APPEALED TO THE MIAMI-DADS COUNTY
COMMISSION ON ETHICS AND PUBLIC TRUST. In the event a lobbyist fails to
either file the report and/or pay the assessed fines, the Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust.
IN ADDITION, ONCE AN ISSUE I HAVE REGISTERED TO LOBBY ON HAS
BEEN RESOLVED, 1 AM REQUIRED TO IMMEDIATELY NOTIFY THE CITY
CLERK'S OFFICE OF LOBBYIST WITHDRAWAL IN WRITING.
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a ure: ate: