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James Russel Mackenzie - La Gorce Country Club, Inc.r '~ m MIAMIBEACH L Q ~ G ~~~ p~.~s~ 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 modificatlon of any ordinance, resolution, action or derision of any commissioner; any action, decision, recommendation of the Ciiy Manager or any dty board or committee; or any action, decision or recommendation of any dty personnel during the time period of the entire deasion-making process on such action, derision or_ tcommendation that for+eseeabfy will be heard or reviewed by the dty commission, or a dty board or committee. The term specifically inductee the prindpal ~ well as any employee engaged in lobbying activities. The teen "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. NAME OF LOBBYIST: (Last) (First) (M.I) cht~~'~~-~~'('KS LC 3~p ~ ~'I~ S~ree~ v~ t~11 ~~ ~ 33 ~ x-11 B SINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 3c~ ~6~ 16 Z3 666 ~, ~ I ~ar~h,~' ur~K TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this oi~ce if your contact information changes: address, phone, ore-mail address. I. LOBBYIST RETAINED BY: ~z ~0(G2 (~hXY~Yt/ el.U b ~rG ~ ~a'Yui 1y~ NAME OF PRINCIPAUC,LIENT: / T ~ ~C~e C~~~YY Ctab ,~_ ~;; --~ ~. ~+a~,13 ~L- .331 ~ . G`~V1'~ 1 tt_tNHUNt NUMBER: FAX NUMBER: (Optional) t EMAIL`~Optional) out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)~ • 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: II.SPECIFIC LOBBY ISSUE:i _ _- 11~,~ Issue to be lobbied (Describe in detail): _ - _ ul. 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 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 Individual Title B An Financial, Familial or Professional Relationshi ~~ 1 ~ ~Pir1 I ~ ~b ~~ ~- ~.~0 O~QZ ~~i ,y _. o IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ® " GO/IiI~E'R.~S T7®~~7~0/~ lei °~ r ~ O ~ l'3~'+~-'~Onl. The following information must be answered: NorJ' ~~OF~T CJe~i~i~!/.~.~'7~1or~l . 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": ^ Yes L~ No: Are ou lobb in on a resent or endin bid for oods a ui ment or services or on a r ~ ~ ~ ~ Dresent or Dendina award for goods. eauiament or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real estate Development Issues": aaDlication for chance of zoning maD designation or chance to the Citv's Future Land Use Mme? 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 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 Gerk as required by this section but, shall not be required to pay any registration fees. reimbursement. . V. SIGNATURE UNDER OATH: I do solemnly swear that all provisions contained in Sufi are true a~Sd correct anSi'that I have read or am familiar with the Beach City Code and all reporting requirements. ~'roduced ID !y~'S~a?~S/~,^~~~~~,~ 0 Produced ID Form of Identifi ~ ~~~ii Form of Identification FPM ~~ HA T,cjF ~~~~i ^ Personally known (Lobbyist) ~ : ~~~ ~~a~t 18 ~o~O9~ ;(,Personally known (Principal) s _i VII. SIGNATURE AND STAMP OP~~'ARY:°'~ 2 : #DD 832367 ' ~= State of Florida, County of Miami-Dade ~~y'•.~ie ~ndeat~~°;' o~te of Florida, County of Miami-Dade Swom to d subscribed bef re e ~'i9~ •'y~i°1io~idg °• `~~ This ~_da of 2010 ~~~~~ti e~~C•STA'~~~~~~\~wom and subscribed before me Y ~ ~~~~~l~liiil~,~~~°~ This day of .2010 'a~ S gnature of Public Notary -State of Florida Signature of Public Notary -State of Florida Notarization of Lobbyist's si~pature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: ]Yes [ ] No Amount Paid $ MC # Date Paid Lobbyist Registration Fonm received and verfied by: F:~eL~~~~A[.~1aFOa.MSl~ossYas~r FoRMSSLobby6st Reg6str ~o. Revised 05/28/ VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: r'' , IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) /SloiV f ~~T 01 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). The following information must be answered: i~ /~a~©- ~cl~ Go~1I°~.~5 7 ~Vonl /QD ~T L~i~i~/~7r1 ors! . Oe~t ,F~O•K 1) Pursuant to Miami Beach City Code Section 2-488 Entitled °Prohibited Campaign Contributions By Lobbyists On Procurement Issues": ^ Yes No: Are ou lobb in on a resent or endin bid for oods a ui ment or services or on a aresent or sending 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": apalication for change of zoning maa designation or change to the Citv's Future Land Use Maa? 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 .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. SIGNATURE UNDER OATH: ON OCTOBER 1~ OF EACH YEAR. EACH .LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH LISTING LOBBYING EXPENDIT S WELL AS .COMPENSATION RECEIVED IN THE CITY OF MIAMI BEACH FOR THE P EDIN CALE R YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDI S O _ ATION DURING THE REPORTING PERIOD. I do solemnly swear that all e provisions contained in Se l0 2 Signature of Lobbyist: Form of Identm~ca~Q~r~R. HATFjF~i,~~ ~,~ O~N,ISSION~A~~ i~~` ^ Personally known (Lobbyist) i : mac, ~~aN 18 ~0 9 ; ~o ~ . . __ VII. SIGNATURE AND STAMP OR~lARY:°' ~ 2 : #DD 632367 ~ Q= . p~ State of Florida, County of Miami-Dade ~~~y9`~~~, pct ;•~c~ate Swom to d subscribed bef re a ~, ,o •...o...• F two This ~_day of 2010 ~~~~ii ~Qjj jc, ST Al i ~ ~~~~This +~ ~ Ifllltl S gnature of Public Notary -State of Florida gn v st s s~ re n TO BE COMPLETED. BY CITY CLERK'S .STAFF ONLY Annual Registration fee: ]Yes [ ] No Amount Paid $ ° _ MC # Lobbyist Registration Form received and verified by: F:\~I.ER\$ALL\aFORMS\LOSBYYST FORMS\l.obbyist Registr ~ Form. .. ~, Signature of Principal/Cent: VI. LOBBYIST IDENTIFICATION: Produced ID ~l~i tea? Notarization of Lobb i ' '~ ~~~~ ~` Ufa are true acid correct anSi'that I have read or am familiar with the the Mi mi Beach City Code and all reporting requirements. ~`` PRINCIPAL IDENTIFICATION: 0 Produced ID Form of Identification ersonally known (Prin of Florida, County of m subscri c day f re li to riza on of ri cinaP -~ 7 '~ ~ol~~l ~Va" Notary Public $t6t11 of Flgrida • Mabel Padron-Hernandes < My Commission 00930388 ~'~~~,~qp Expires 12/16/2013 ~Gr 2010 ate o signature Date Paid Revised ! ~~{/~~ r 7 m ,MiAnnaEacH City of Miami Beath, 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: .~l~iE roc?- - 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 colendar 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 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. D /~ natu ~ . at .