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Randall C. King_~ ~Q~ _ ~o '~ City of Miami Beach Office of the City Clerk ~ ~ ~ 1700 Convention Center Drive, Miami Beach, FL 33139 'LOBBYIST REGISTRATION FORM Lobbyist means atI 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 speclfrcally includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has speclflc exclusions. Please refer to Ordinance 2004-343fi. I~C1 ~ ~ ~~ >~L~ c NAME OF LOBBYIST: {Last) (First) (M.I) !-©K I a A- L1 vT ! TiEA , ~.. ?- ~tQ3S cv~ uat a'JE ~1~,p-rii, afA~t(j FL 3J1~ AND ADDRESS (Number and Street) (City) (State) lZio Code) rk~:~~ @ M.~yladaQ.~~ TELEPHONE NUMBER. FAX NUMBER: EMAIL: P/ease notify this office if your contact information changes: address, phone, or a-mail address. I. LOBBYIST RETAINED BY: NAME OF PRINCIPAUCLIENT: BUSINESS NAME AND ADDRESS (Number and Street) (City) {State) (Zip Code) TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) out this sectlor-1f arincioal is a or • 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: NPR FILE ~o. X196 `~~35 Co~b4i~s ~JF-G~R.A~D g~~~ ~~T'~ Issue to be I bb d D (dual Title B) Any Financtal, Famtltal or Professtonal Relatronshlp S To R C 1'~P~SE~tfit-7r o~ o.~R D :6 ~'~ ~-1 d3S OIOZ , , o ie ( escnbe in detail). , s ul. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Cade Section 2-482(81 include ~~ x 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 ° • personnel' commencement of~ service with the Gity to 'the present date, stating the general nature of the subject; contractual relation. A Full Name of Indiv' , ~~ s~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) ~~~~,~'~~L B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):; ~°t'~'`y (~ (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 lobbying on a present or pending bid for aoods equipment or services or on a 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": ^~ No: Are'vou lobbvina on a pendina application for a Development Agreement with 'the City or application for chanae of zoning map designation or change to the City's Future Land Use ., ~ Maw? , ~m~ W O N~ O ,M„ a x a ~~~~ ¢Z ~~~ U X ~' >w~ g 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 representina anot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: I do solemnly swear that ail of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained in Sec ~ - of the Miami Beach C'ty and all reporting requirements. Signature 'of Lobbyist: - ~ F Signature of Principal/C LOBBYIST IDENTIFICATION: Lt~~ y ~j ~Produ ec dGID r1J!o~'7013'/ /,3~7 L~ Form of Identification ^ Personally known (Lobbyist) I. SIGNATURE AND STAMP OF NOTARY: tate of Florida, County of Miami-Dade worn to and subscribed befo a me his day of 2010 ~ . ~`~- ~ Signatu~ of Public terry -State of Florida Notariz tion of Lobbyist's signature PRINCIPAL IDENTIFICATION: Produ~d ID L ~~~ • 7a3- ~f7- 3~7 c..~ Form of Identification ^ Personally known (Pri , ""`~~ P ~ ~ ISABEL SATCHELL ~ '; t.1Y CAMMISSIDN p DD 819891 ^'I " `' EXPIRES: April 13,2013 -~ - 3uniled thru Notary Publk Underwriters State of Florida, County of'MiaiYii=`I~ e Sworn and subscrtb d bef a me This ~da f ~ , 2 10 Signature Public Not - ate of Florida Notariza 'on of Principal's signature TO BE COMPLETED BY CI CLERK'S STAFF O LY Annual Registration fee: ]Yes [ ] No Amount Paid $ CR # Lobbyist Registration Form received and verified by: ' F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form 2010.doc Paid Revised 058/2010 m MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miomibeachfl.gov CITY CLERK Office CityClerk@miamibeachfl.gov Tel: 305.673.741 1 ,Fax: 305.673.7254 Acknowledgement of fines/suspension from lobbying for failure to comply with .City of Miami Beoch lobbying .Laws LOBBYIST NAME: ILi~ ~ A" L L ~. KI BJ Cr 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 70 THE MIAMI-DADE 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 1 HAVE REGISTERED TO LOBBY ON .HAS BEEN RESOLVED, 1 AM REQUIRED TO IMMEDIATELY NOTIFY THE CITY CLERK'S. OFFICE OF .LOBBYIST WITHDRAWAL iN WRITING. ~l ~ `v Si ure: ~- Date: