Loading...
Mike Dee - Harold Talisman Prof Sports Franchise . 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. Ch° ffict NAME OF LOBBYIST: (Last) (First) (M.I) �. �� �1z ► u c) Ccr . , L C 3 fl Cpl . to ft . 3pq BUSINESS NAME AND ADDRES (Number and Street) (City) (State Y) ( Code) ( ' Yll3_ )1 It .1a CO 1 IN TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes: address, phone, or e-mail address. LOBBYIST RETAINED BY: Wcik1 1oV ■siT0f1 NAME OF PRINCIPAL/CLIENT: FLIrr iiuf Corp. c 3-f1 f Or, Mia.blydP c- L 3339 BUSIN S N • E So (Number and Street) (City) (State) Code C-tY) S le II e i ( ) Zi (p 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: QocrnSpk f n f sCll 1� Issue to be lobbied (Describe in d ail): III. CITY AGENCIES /INDIVIDUALS 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 NONE v(2.-//7 0 • IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) ' 0 id& B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): 00 C.C{ � d . (Required). po The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2 -488 E ntitled "Prohibited Campaign Contributions By Lobbyists Y Y Y On Procurement Issues ": ❑ Yes o: 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 14 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 a llo: Are you representing a not - for - profit corporation or entity without special compensation or 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 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 EXPENDITURE • - COMPENSATION DURING THE REPORTING PERIOD. ' l - Signature of Lobby t I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2 -48 of the Miami : -ach City Code and all reporting requirements. / Signature of Lobbyist: Signature of Principal /Client: '"` '"'! 1.„.•„ -- VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: W ti ❑ Produced ID ❑ Produced ID W c c Form of Identification Form of Identification V0 a N 0 r Ili ..Personally known (Lobbyist) ,Personally known (Principal) I a. © ci VII. SIGNATURE AND STAMP OF NOTARY: v_� P. z 02 c s a State of Florida, County of Miami -Dade State of Florida, County of Miami -Dade v >< 4_ Sworn to and subscrib bef me Sworn and subscribed bef re me Z Thi 1 day of , 2010 This d of , 2010 i n ure of blic Notar — State of Florida Si nat e of Pu c Nota — State of Florida - 9 Y 9 rY Notarization of Lobbyist's . gnature Notarization of Principal's signature " ,�,�� ` TO BE COMPLETED BY CITY CLERK'S STAFF ONLY NLY , Annual Registration fee: [ ' ] Yes [ ] No Am ount Paid $ 'c' /MCR # 0 , Z � Date Paid I � / fr Lobbyist Registration Form received and verified by: j - _ 1 F: \CLER \$ALL \aFORMS \LOBBYIST FORMS \Lobbyist Registration Form.doc (> W Revised 05/28/2010