Mark Cole - Miami City Ballet, Inc. 6 .fLo
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. 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.
Cole Mark
NAME OF LOBBYIST_ (Last) (First) (M_I)
Miami City Ballet, Inc., 2200 Liberty Ave., Miami Beach, FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305 -929 -7000, ext. 1500 305 - 929 -7002 Markc @miamicityballet.org
1El_EPHONE NUMBER FAX NUMBER EMAIL
Please notify this office if your contact information changes: address, phone, or e -mail address.
LOBBYIST RETAINED BY:
Mark Cole /Miami City Ballet, Inc.
NAME OF PRINCIPAL /CL IENT
MCB, 2200 Liberty Ave., Miami Beach, FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305 - 929 -7000 305 -929 -7002
TELEPHONE NUMBER_ FAX NUMBER (Optional) EMAIL. (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2 -482 (c)]
• NAt,1F OF CHIEF OFFICER. PARTNER. OR BENEFICIARY Pamela N. Gardiner
Executive Director
• !IDENTIFY ALL PERSONS HOL DING DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OP TRUST N/A
ii.SPECIFIC LOBBY ISSUE:
Grant Application to City of Miami Beach Cultural Affairs Program
Issue to be lobbied (Describe in detail) Tourism & Cultural Development (Cultural Anchors)
CITY AGENCIES /INDIVIDUALS TO BE LOBBIED:
Pursuant to City Codo 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 commissionor or personnel from 12 months preceding such person's
Sec 2-482(a)(4) e with Name to he present
Individual and —
commencement of service with the city to the resent date, stating the general nature of the subject contractual relationship.
Contractual Relationship (Explain) YES NO
title of person to be lobbied
Miami Beach Cultural Affairs
Council Members
Pursuant to City Code Soction 2- 482(g) Every registrant shall be required to state the extent of any business, financial, familial _ - so
professional
relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner or city personnel who is
sought to be lobbied as identified on the lobbyist r gistration form filed. �JA� ll` �
Sec 2- 482(g) Any Financial, Familial or Professional Relationsh� or IL!'
NI OC :S d ICN -ViI
- - IOZ
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE (Required)
0
B) PRINCIPAL'S DISCLOSURE OF LOBBYIST COMPENSATION) 0
(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 J No: 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?
2i 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 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 Beach City Code and all reporting requirements.
Signature of Lobbyist 1 .---L
Signature of Principal /Client mi City Ballet � � `�
VI. LOBBYIST IDENTIFICATION: R .2 I PRINCIPAL IDENTIFICATION:
2 $ lisfif
(1 Produced ID $ 8 4 ❑ Produced ID !!!1
Form of Identifica ' i I I Form of Identification
�t' P a
i
L1ersonally known (Lobbyist) i i ' IS�Personally known (Principal)
I
VII. SIGNATURE AND STAMP OF NO c c I
State of Honda County of Miami -Dade ��,•N ,{�� I State of Florida, County of Miami -Dade 7, • s • Sworn to and subscribed before me �,'- Sworn and subscr •ed before me
This _Q _ day o F� 2011 �i ti I This �} day of �� �� 2011 s of
a k, Signature of Public • •tary - State of Florida -- « 4 Signature of Public Notary '.tate of Honda
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ j Yes [ j No Amount Paid $ MCR # Date Paid
Lobbyist Registration Form received and verified by:
L ci 7) 411 `.) N7)+,S',LCf3P FoI - -uls L o';byi ...t Aneu:)1 R q - )_:,iron r-erni_rloc Revised 1/11/2011
City of Miami Beach, ' 11 �
IT CLEF' I- 2miankeachf1 _gw
.III F 3 0 - 25,1
LOBBYIST NAME: Mark Cole
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.
Signature: a te:
\<
o ��