Renee A. Rentmeester - David Newm MIAMIBEACH
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LABBYIST REGISTRATION FORM
Lobbyist means ail per~rs empbyed w retained, whetlier paid w not by a prindpal who seeks m encourage the passage. defeat or modiRcstion of
any ordinance, resolution, action w decision of ar>)r oommisskmer, any adbn, decision, recarrmenda8on of the City Manager or any city board or
oommtttee: or any adfar, decJslon or recommendation of arty dty Personnel during the time period of the entire dig pnm~s on such
action, declsbn w recommendation that foreseeably will be heard or reviewed by the dtY r~nrmission, w a dty board w committee. The term
spedficatly h~ludes fhe principal as well as arty employee engaged In lobbyiing ai~vities. The berm "Lobbylaffi".has spetUlc exclusions. Please
referto O nonce 2004-343ti.
r~nrvrcvr r.vwrrvr. (Liao[) ~~ 1 J~ (I"IrSiJ ~~~ ~ '/~07M.1) .
t ~ i o~ ~Q ~o~ 1 d; ~ ~.~,~-r 1Y1 i arti; ~ ~ L-- 3~ l S ~
3a s.
6
nrt this section ff prlrrcipal is a Corporation, Partnership or Trv
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFlC[ARY:
• IDENTIFY ALL PERSONS WOLDtNG, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:.
II.SPECIFiC LOBBY ISSUE:
vc:~ f'~. ~- ;-
A Full Name of Indhdduai B An Financial, FamiUal or Professional RNationsbt
.
~~ 1 c t~ `
F ~6
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TELEPHONE NUMBER: FAX NUMBER: EMAtL:
P/ease notify this office /f your contact information changes; address, phone, oramail address.
Iti. CITY AGENCIESIINDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-A82(~j inGude
.a statement of the extent of arty business, fiharrcial, farniNel, professional w other relattonshiP, giving rise to en
appearance of an [nrproPrlety with arty City personnel sought to be lobbied -further, pursuant to City Code Section 2-
482(a)(4) include a statement of arty corrtracbml .relationship (paid or unpaid) from 12 morrtlts prBCeding said City
personnel' commencemerrt of service with the City to the ptesent date, stating the general nature of the subject
contracdial relation. .
R/. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE V1piETHER HOURLY, FLAT
~ RATE OR OTHER): •
.A)• LOBBYIST DI~~LOSURE: (Required) ~ ~~ - -
B) PRINCIPAL'S 1 CLOSURE (OF LOBBYIST CQ~IPENSATION):
(Required). ~~-~ Cam" ` Sl~-a-r.-~'-c_~c~•-
The following infonnation must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
O,..n,~Procurement issues":
^ Yes UdNo: Are you iobbyina on a present or pending bid for goods, equipment or services or on a
present or pending award for cloods, 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 f~No: Are you fobbvina on a pending application for a Development Agreement with the City or
application for change of zoning map designation or change 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
"fobby(st° as set forth in Section 2-481 above) who only appears as a representative of a not 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.
reimbursement. .
V. 81CiNATUR;E UNDFJt.OATH:
I do solemnly swear that ail .of the foregoing facts are tale and correct and that 1 have read or am famtllar with the
provisions contained in S~e~-4821 the Miam~ach Cjiy Code an¢~Ii reporting naauirements.
Signature of Lobbyist:
Signature of PrincipaUCiienir ,, ~~1 \d- 11~jdLh)
VI. HOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
L4'Produced iD ^ Produced ID
Form of Identification
^ Personally known (Lobbyist)
V(I. Si(3NATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of , 2010
Signature of Public Notary -State of Florida
Notarization of i-obbvist's signature
- TO BE COMPLETED BY C11Y
Annual Registration fee: ]Yes [ ] No Amount. Paul $_~
Lobbyist Registration Form received and verified by: _~
F:\CI.Bi\#AI-L1eWRMS1tA86YISr FORMS\Lobbyiat Registration Fon
Fonn of identifiption
L~ Personally known (Princfpai)
State of Florida, County of Miami-Dade
Swom_ grill sub cxibed before me
This " da G V 5 T ,~Q10
Signature of Public idr~ry -
Notarization of Principal's
LERK'S STAFF ONLY /L
Revised
vy
S127'~/d
~~`'~ ~ P:'~% MERLYN A(30SS11N1
* MY COMMISSION q DD 907278
EXPIRES: August 7, 2013
''xrF v. oP\OQ Bonded Thru Budget Notary Sendoes
Pala
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Sig furs of Lobbyist
lSep 02 10 Ot3:19a p.2
:V. QISCLOSUR: OF T'£RM5 ANO AMCtUNTS OF L086Yt5T GOMpENSA"r10N (DISCLDS£ W1iE'~ eiER HOURLY, FLk;"
i RA 7'~ OR OTNEii):
~ A)• LOBSY157 D1$ I:UC, 5:1RE: tR~qu'aad) ~ `~
c~ C ,~-Z. ~.~^c--r--r.
B' PRfNO1P.Ai.'S Dt,SCLOSUfi° {Or LOBBYIST PEN5ATION):
(Regs,ttred). ~ lam. ~~~~ ~-r.~ _
The tallawtng informatiGn mast bs answered:
' 1) Pursuant to Miam1 Beach City Cods Section 2.468 Erditled "?rat•Jbited Car^paign C:trtlt~utions sy Lobbyists
D..;.-,/Pro~.irsment lssuas": '
• ~ Yea _ ~ No: Areyou~ lobbylna on a argent or pending bid far gaorts, eau;pment or services, ar on a
nee®nt or oendir:a award far goods, equipment ar service?
~ro
3} . Pursuant to A+9ia~ml Beach City Cade 2--494 (h) Any parson (except those exempt Pram tha deflnltan of
"lobbyist" as set forth kr Section 2-~iS1 aDcve) who only appears ss a r~pre`entative of a rat far arofit
~rpnratian or entity wtthouf spedal compensation or reimoursement fur the appearance, evr,ethsr direct, or
indirect, 1o express s~pa>i of nr opposition to any item, ahsl's rag;star with tt;e Gerk es r~quireti by this
section but, shall no: be regWrtad to pay any re~istratiorrfees.
L1G Yes~l' f~ta~ Ate v~u„ renregerrtina a nofrfor-uro$t cprpor'ation or srrtfty without sDeeiet carnoeresatton or
~lmbureement, .
U. SIGNATURE UNpE.Ft .OATH:
i do solemnly swear that ail .af the foregoitag facts are tn;e and correct and that i hays read or am E~ttar with the
provisions vontained in Sec' X82 a the Mlam' ach C;ty Cade a II reporting rgyuirements.
r
Signature of Lobbyist; _ ~~._.-_ ~ ~ ~~._ ~ _ ___
Signature of Prin:~pr>iiCkieni '~ _.~-;..~`, ~.~ ~%G_~~ _
Vi. ,~ LOBBYIST IDEN'!"iFICATION: PRINCIPAL iDENTIFlCATION:
t~roduced 1J~vf~il?)~ J,w'(cc~S r:~ik>'~:~ ~ Prcr;.'uceG tD
'Form of fdentrtcation Form of kdenti6c~tian
PersonaNy known (Lobbyist) Personally known (Principal}
dl1. SIGA1ATUitE ANU 3TANdP OF NOTARY:
Stale of Florda, Courrty of nrtigmi-Dade ~,? ' ~L St3ts of l=torida, County of Miami-Dsae; r~-=-~
Swom to and subscribed before me le~:bf,~.ra ('Zi~~i' Sworn a ~ sun cribetl be~ore ms
''his ? ti1~f, r",_,d~ y of ~ r 20,$C?,".'~:;"<~ ~ hIEI~.Y't~AG ~da f G U s ?" , ~1 G ,~ . „ +t.,z+l 31G°?,! L
~ ~ _G~~, MY Ct]tdtA1$CION 9 Dfl9r,727d t*T`Y °~
/!'~ „ ~ ., ....,°~r tAERIYN AS05i7NY
~V ~ eXPIRES:August7.2Ui3 ~P (~' ~ .,, MYCOMiAISS~tC68G1~
Signature Pi:biid,Nata. - fate ofv "-~' 'a~ca~rn~e~eecr~~itrre o Pu Ac Na~f ry - to of FI EXPIRES: August 1, 201
t~atarzatton of L;.O.bbyist'~ st tore Notarszation of P,rJ'nci~$!'a,/tgnature "~~~ .~„~ `,CFaxi~dTfvaAtdgatNotar! Ssrv
TO Bc. COM?LETEp $Y CS1V CLERK'6 STAFF ONLY /v - 691e ~ / ~
Annual Ftegi6ttatiun fag; ]Yoe [ ; No Arnwrn; Paid; ifICR# DOko F'ald
t..obbyis: f2eQistral9on Form received and verifiad by: _ `
g:1CLER`SALL1aPORNt6li.0atT'YLST FaR-~I.Sltohn9~tat iaegisrtstioe Fnrm :LOill.dx Rgyjaed d~5~f2Q20 I
2) Pursuant to Miami @eech City Code 2.480 Entttied "Prohibited Ca.mpeign Cnntrifrufio;!s ay Lobbyists On
+~ea1 Estate t~evelopment Issues":
~ ~ ~
Sig furs of Labby~st
`~ MIAMIBEACH
ITEM 3
City of Miami Beaeh, 1700 ComenHon Center Drive, Miami Beach, fbrida 33139, www.miamibeachN.gov
CITY CLERK Office
Tal: 305.673.7411 ,Fax: 305.673.7254
CityClerk(~m iam ibeachfl.gov
Acknowledgement of fines/suspension from lobbying for failure~to
comply with City of Miami Beach lobbying Laws
~.
LOBB1IST NAME: ~ ~ ~-S ~T~Y
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
1NILL RESULT' IN A FINE OF .$50.00 PER DAY. ANY LOBBYIST lNHO MILS
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 ~I'FIE MIAMI-DADE COUNTY
COMMISSION ON ETHICS AND PUBLIC TRUST. In the event a lobbyist fails b
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, I AM REQUIRED TO IMMEDIATELY NOTIFY THE CITY
CLERK'S OFFICE OF LOBBYIST 1A/ITHDRAWAL IN WRITING.
~, ~~A ~ C~
Signature: - Date: