Robert S. Goodman - Art Basel Miami Beach
~~~
~~~~~ ~ ~~sEL
~~~
~~~~~
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 specific exclusions. Please
refer to Ordinance 2004-3435.
NAME OF LOBBYIST: (La1st) ,I ~ (Fi/rst)~ _ / (M.1)
L~ • ~/ ~..,~i~ 7 . ~/~ /-~/id/r1i ~dG/J ~ ~/mod
BUSINESS NAME AND ADDRESS '~ (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: ~./ `J EMAIL:
__ .:
Please notify this ofifice if your contact information changes: address, phone, or a-mail address
1. LOBBYIST RETAINED BY:
i t~trnvrvt rvumrstrc: f-PJCNUMBER: (Optional) EMAIL: (Optional)
out this section if principal is a Corporation, Partnership or Trust [Section
• 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:
Y~ ~ _. ~ . ~. ~ ~ ~ ~s~ ~
Issue to be lobbied (Describe in detail):
,_
...,.
ut. CITY AGENCIES/INDIVIDUALS" TO~ BE LOBBIED;: Pursuant to city Code section 2.4s2(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 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 Individ
ual Title B) Any Financial, Familial or Professional Relationship
1
l I
r Q,/~~
I ti ;~ ~t~ U I f).~S ~~~Z
:..~ ~~ i; 4. ~ ..9 ~+ ...E
~~
,vot ~,~ _ P,~o~,r
ly, DISCLOSURE OF TERMS ANp AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY FLAT '
RA>7E OR 07H~Rj: ~" ~+
AI ~OBBYIST~IISCLOSURE: (R~9,uir5d) ~~ ~/~ ~rC~YrS d fC/tri/.i°/-7"GE' ~r ~/"""r'
The following information must be answered: v
1) Pursuant to'Miaml Beach City Code Section 2-488 Bntitled "Prohibited Campaign Contributions By Lobbyists
O,,n/~Procur~ment Issues":
n v~~T~y, No• Are vo tobhvlnn on a aresent or oendino bid_for goods. eaufament or services. or on a
present or aendina award for Bloods: eduiument or_se~ee?
2) Pursuantto Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By tobbyists On
Real Estate Development Issues":
a) Pursuant to Miami Beach city code 2-484 .(h) Any person (except those exempt frorn the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a roprescntative of anot-for-profit
corporation br entity without special compensation or reimbursement far the appearance, whether'di~ect, or
indirect, to express support of or opposition to any item, shall register with the clerk as required by this
~s.~e(ction but, shall not be required to pay any registration fees.
Yes 1lCl No: Are you rearesenflno a not•for-profit coraoration or ®ntity wi hout siaecial compensation or
relmburs®m®nt. .
V. SIGNATURE UNDER'Oi4TH:
~~, ~/~TAI]Cf7 SST nC GALL. VL"11A CA ALI I A~AV,!•T wi1~. I l-..l~"",T Tw ~t,n w,.w~i w..-w.i " w. w~.w..
I do solemnly swear that of the f ageing f ?t~o true and an t I have read or am familiar with the
provisions contained in S lion 2j:f t~ (~~I~RJy°e~ Ci ode and ali rep ing requirements
Signature of Lobbyist: `-~ I'
Signature of PrincipallCllenf: ~j~,pj~~g,~/,~ ~ i o,~~~~~~
~..~%
Vi. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICAT
~1 Produced ID F.Cd.G • ~ Produced ID
Form of Idehtiflcation Form oil entlflca Ion ®~:~
~. n
$ ^i ^ Personally.known (Lobbyist) ^ Personally known (PHnclpat) ~ /~ -
'° ~ !ll~Ltt/// ~~1
~ s ~• VII. SIGNATURE AND STAMP OF NOTARY: /~
¢_
~ ` State of Florida, County of Miami-Dade State of Florida, County of Miami-D;Ide
y, „~ ~ Sworn to and subscribe befo mo Swom and subscribed before me
~ ~ This /D ay of 10 This day of , 2010
f «"~~ =_
~• z; 'Signature f Public - St of Elorlda ~ Signature of Public Notary.- State of Florida
~+q~"~y~'~'~_ NotaNza on ofiobbvlst's nature Notdfization of principal's Signature
• ~.~`ow1T•,•
TO 8E COMPLk'i'ED BY CI CLERK'S STAFF O LY
Annual Registrdtion'feei ] Yos [ ] No 'Xmaunt Patd S MGR # •:bate Pald• •••' •
Lobbyist Registration Form• received and verified by: , ,
:\f'CER\~tALI_\nFt>rLMC\i.QR9~'X:SYPbgMS\LoGi~}•iy#.Rrgi~dtilffl t"an~.dpr - -.~ ~ rj~ _. 'pev:eeil ne.~Q~!fn~ev:.
~~;?~~
i
i
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, 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: ~~T 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
County Commission on Ethics and Public Trust.
IN ADDITION, ONCE AN ISSUE I HAVE REGISTERED TO LOBBY ON HAS
BEEN RESOLVED, I UIRED TO IMMEDIATELY NOTIFY THE CITY
CLERK'S OFFICE OF L BYI WITHDRAWAL IN WRITING.
X 9~~0
gna re: Date: