Judy L. Stein / /1- 1)91' fi/Pt
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City of Miami Beach Office of the City Clerk 5 vki , o
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.
S JO (
NAME OF LOBBYIST: (Last) (First) (M.I)
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S vv i m t, a f PrSSoC i q-li on of f l o r i cl ci 1'900 S'IAJ (I! "1 Ave C lb Miu my FL
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 331C°
'505 -5°14.0 7rtrq 30S- - 77 (3 Job\I P SvolmsHow corn
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes: address, phone, or e-mail address.
I. LOBBYIST RETAINED BY:
JO CIy S-Fein
NAME OF PRINCIPAUCLIENT:
S mWCGr pSSoC(Ct - (ton Irrr FlOr ggoo SvJ II7*' Ave C2os Miami,FL
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 33 ( �6
305 -cq - irts :;nc-cct ,- 1713 p swin IA) . to
TELEPHONE NUMBER: FAX NUMBER: (Optional) MAIL: (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:
u.SPECIFIC LOBBY ISSUE
H i trn c.Och Vis i • Convr.nrton P*v - I - hor ity Tporifnr- F 1voncernent
Issue to be lobbied (Describe in detail): i i 6C1 ro n(1 2.D1 0 120/1
nl. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2- 482(a)(4) include the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's
commencement of service with the city to the present date, stating the general nature of the subject contractual relationship.
Sec 2- 482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES NO
title of person to be lobbied
VCA firtlth0ritiCS Non(
Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extent ofj i, s or other relationship �' el l a , � or professional
relationshi p p
p, p giving rise to an appearance of an impropriety, with any current city com s t ersonnel who is
sought to be lobbied as identified on the lobbyist registration form filed. Z ��� W �
Sec ^ 2 - ' 482(g) Any Financial, Familial or Professional Relationship 7 7 8 .NV
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on 1p. 03A13038
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
%C (‘ )
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): Q
(Required).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues ":
❑ Yes v' o: Are vou 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 lo : Are vou 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.
Y es ❑ No: Are vou 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. C kf
Signature of Lobbyist / •'
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 2-482 of the Miami Bz1 rn City Code and all reporting requirements.
Signature of Lobbyist: ''I i
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Signature of Principal /Client: /1° 19
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VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ni
( N Produced ID D 1-- ❑ Produced ID
Form of Identification Form of Identification
❑ Personally known (Lobbyist) ❑ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami -Dade State of Florida, County of Miami -Dade
Sworn to and subscribed before me ,,; Sworn and subscribed before me
This 13h4) day of SC\ . 208, • • This day of , 2010
Signature of Public Notary — Stateof'Flcrida Signature of Public Notary — State of Florida - • T
- • Notarization of Principal's signature �a/ /a jfO/2 _ ./fP�,, ;
, '--: - \ MARIA N. �/ r , D
BE C MPLETED BY CITY ERK'S STAFF ONLY / / /' /—��
L r 4: . ' A' maunt Pald $ MCR # Dat Paid 1
r ` : .. ' t \aPO L I ,1a• istReo st:3tion Form 2010.d Re vised 05/05/2010
t AMIBEACH
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:
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.
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Signature: / Date: