Loading...
Leroy Charles Griffith - Club Madonna � e I itA NA I A g � 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 ordnance, resolution, action or deasion 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 dty personnel during the time period of the entire deasion- making process on such action, decision or recommendation that foreseeably wit be heard or reviewed by the dty 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: G ` (La ( � ( ) st) t C h ip . •• /� .� rr ►s.. _ �: i 1 111IS..ft. C - ea - .. 13t, BU INESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) '� © — 4 ' 30 - ` z — G ic r\C'Nc - e1►0.\-,T r ce) (Nrm..corc, TELEPHONE NUMBER: FAX NUMBER: - EMAIL: Please notify this office if your contact information changes: address, phone, or e-mail address. I. LOBBYIST RETAINED BY: /� ma y, I "o! A--.5 A-6 U u NAME OF PRINCIPAL/CLIENT: BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill 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: R 51 C L Q q m o or r iv i}- kt 0. 0 i. r (' 4Lcotfo L Issue to be lobbied (Describe in detail): III. CITY AGENCIESIINDIVID 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 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) Any Financial, Familial or Professional Relationship I x\1 4� Ca I"j in/SS 16 ivF� NO • - j } ''J_J9? :7 SC .h kd ' 1 Al/3 1 30 Ow 7: i • IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) A' s ,e2) B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): I ' ,,� 1 n ' -, (Required). do e q_ Ot J0 ^- -- e4 7 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 ,�jNo: Are you lobbying on a present or pending bid for goods, 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 ": ❑ Yes No: Are you lobbying on a pending application for a Development Agreement with the City or application for change of zoning map designation or change to the City's Future Land Use Map? • 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. ❑ Yes No: Are you representing a not - for - profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON FEBRUARY 28th OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature o obbyist / I do solemnly swear that all of the foregoing facts are true and correct and that have read or am familiar with the provisions contained in Section 2-482 oft • iami Beach City Code and all reporting requirements. Signature of Lobbyist: —d._ ___ i nd Signature of Principal /Client: P� VI. LOBBY r I -- ST I PRINCIPAL IDENTIFICATION: � roduceed iID G ,� - 5 3 - /t -� � 'Produced ID C.; 61.3 --5P 3- —404. -(J Form of Identification Form of Identification d o $ 0 Personally known (Lobbyist) 0 known (Prim _ ° ; F`•'" P ISABEL SATCHELL U - _.: 'a :.: MY COMMISSION # DD 879891 8 oz . 11. S IGNATURE AND STAMP OF NOTARY: a „, :4 , w2 _ ±� EXPIRES: April 3, 2013 w a ;5<--t-s. ' • tate of Florida, County of Miami -Dade State of Florida, County of Mi `'p • Bondetl Th u Notary Public Underwriters - U -worn to and subscribed • -for me Sworn and subscrib- • be •re me • ”' Z i his 06 d- of �f , 201 This _d Of 40. 01 '.rob, � - 0 ,. C� • I � / � � if :. ; :. • ; t Hatt — ` . pA.. g o ublic Not- • State of Florida Signa of P ublic Notary - State of Florida W. o t ar izatio f of L obbyist ' s si: ature �;�� ;r. , ' Notariz tion of Principal's signature TO BE COMPLETED BY CI CL RK'S STAFF ONLY J / Annual Registration fee: [ ] Yes [ J No Amount Paid $ a 0 -- MCR, • ' U _ , / Date Paid ! 0 2_ 7 Lobbyist Registration Form received and verified by: 41 ,•_, , , l F: \ CUR VSALL. aFORMS \LOBBYIST TOMS \Lobbyist Regis •, or'm 2o1o,dcc Revised 05/05/2010 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 LOBBYIST NAME: Le'< Gc I understand that no later than February 28th of each year, I must file the following form, pursuant to Section 2 -485 of the Miami Beach City Code, with the City Clerk's Office for all active lobbying issues. 1) Lobbyist Expenditure and Compensation Form Failure to file these forms on a timely basis will result in my name being transmitted to the Miami -Dade County Commission on Ethics and for code violation evaluation. In addition, once an issue I have registered to lobby on has been resolved, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. Signatur : Date: