Michael J. Sacks/Orange Bowl Committee
m MIAMIBEACH
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.
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City of Miami Beach Office of the City Clerk Y
NAME OF LOBBYIST: (Last) (First) (M.I)
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BUSINESS AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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Please notify this office if your confact information changes: address, phone, ore-mail address.
L LOBBYIST RETAINED BY:
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B SINES NAME AND ADDRESS (Number and Street) (City) (State) (Zip ode
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T LT L-~Ofl•E NUMBER: ~ FAX NUMBER: (Optional) EMAIL: (Optional)
rut this section If principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ~ I/'iJ ~ ~Q .m S
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
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Issue to be lobbied (D nbe in detail):
ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: 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 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 Clty
personnel' commencement of service with the Clty to the present date, stating the general nature of the subject
contractual relation.
II.SPECIFIC LOBBY ISSUE:
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A Full Name of Individual Title B An Financial, Familial or Professional Relationshl
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N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) s/1 ~'~/1~,
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): /''~'y~ Q ~
(Required). ~ y ~ ~~
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 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":
asAlication for chance of zoning map designation or chance to the Citv's Future Land Use
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3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
°IobbyisY' 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 snot-for-profit corporation or entity without scecial compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of Principal/C
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LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
^ Produced ID ^ Produced ID
Form of Identification
Personally known (Lobbyist)
VII.
SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Swom to and subscri d b fore me
T~~_dAy of_, 2010
Si a re ot"Public Notary - State of Florida
N t ization of Lobbyist's signature
TO BE COMPLETED B
Annual Registration fee: [ Yes [ j No Amount Pald
Lobbyist Registration Forrh received and verified by: _
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbvist Reaistrat
Form of Identification
Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subs ed b ore me
his ~~ of , 2010
ig ature o Public Notary -State of Florida
arization of Principal's signature ~~r-.
CLERK'S STAFF ONLY ~lot~o~' ~~ t~/~ /~. 4
# '~ Date Paid
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Revised
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Signature of Lob t
f do solemnly swear that all of the foregoing fads are true and Corr 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.
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m MIAMIBEACH
City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerkC~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: / "I 1 C N r~1sL-- S ~/.Y~S
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
Covnty 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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Signature: Date:
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