Christopher D. Colgan .m MIAMIBEACH`S F
City of Miami Beach Office of the City Clerk C5/ i
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1700 Convention Center Drive, Miami Beach, FL 33139 20 ll j
LOBBYIST REGISTRATION FORM Ca). �� 2, P " 4
Lobbyist means all persons empoyed or retained, whether paid or not, by a pnncipal who seeks to encourage the passage, defeat or modiifoa T '3
any ordnance. resolution, action or decision of any commissioner. any action, decision, recommendation of the City Manager or any city board or Li t - F1 `
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.
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NAME OF LOBBYIST: (Las (First) (M.I)
FX i l usi yP S ud- �aKkel l') s1 1 anj1'�s�s /v✓( Sum t )D3; �Ca faiW;l
BUSINESS NAME AND A DRESS (Number and reet) (City) (State) (Zip Code)
s(9 1 , boo_ F80 8 Sol 9,4-1-30 s epic un (cO cl usi u . cor,
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes: address, phone, or e-mail address.
I. LOBBYIST RETAINED BY:
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:C VW ts v D- C O( lc(
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sivAk) S- w r r <
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
u.SPECIFIC LOBBY ISSUE: i / ,,,.,,f-,,) _c64 FL__. -s i V
4. Issue to be lobb (Describe in detail):
III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED: Pursuant to City Code ection 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 l
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
s A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPALS DISCLOSURE (OF LOBBYIST COMPENSATION):
( Required).
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 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?
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 S , SUB IT T• - CITY CLE• A SI. NED
STATEMENT UNDER OATH, LISTING LOBBYING E . •ENDITURES • WEL AS •MPENS • TION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE P' CEDING CAL DAR YEA . A S • TEMENT :HALL
BE FILED EVEN IF THERE HAVE BEEN NO EXPEND URES OR COt :•ENSATIO ■URI.•G THE RE'•RTING
PERIOD. /
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is.,.._. :••yist 1 do solemnly swear tha : of the foreg %' g facts . - true and . - t an. at I have read or am familiar with the
provisions contained Section 2 -482 .. Mi�ach a . all rep ing requirements.
Signature of Lobbyi
Signature of Principal/Client: . �j'M
VI. LOBBYIST IDENTIFICATI• • . P• CIPAL IDENTIFICATION:
❑ Produced ID ❑ Produced ID
Form of Identification Form of Identification
LINDA MEYER LINDA MEYER ■ ZPersonally known (Lobbyist), ." NOTARY PUBU 1 Personally known (Principal) NOTARY PUBLIC
` ... STATE OF FLORIDA �'. `' • - STATE OF FLORIDA
VII. SIGNATURE AND STAMP' :v + �+i'• -. +'�
VL►..�' "s�.� • EE028810 Comm# EE028810
• of Miami Dade Expires 1/21/2015 ` Expires 1/21/2015
State of Florida, County State of Florida, County of Miami -Dade
Sworn to and subscribed before me ZO t I Sworn and subscribed before me
This /1 day of �1c, nVa , X1 This It day of Jck.)nQu�N , 2410 2 1
r
S. re o P blic Notary - State of Florida S j re of slic Notary - State of Florida
N..: . .... : of Lobbyist's signature to . - . on of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ es [ ] No Amount Pai •' L MCR # (r �f /,,2, Date Paid / .174,2?"//
Lobbyist Registration Form received and verified by: .-i 4be , /- E / /
F: \CLER \$ALL \aFORMS \LOBBYIST FORMS \Lobbyist Registration Form 2010.doc Revised 05/05/2010
tr MIAMI
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673741 1 , Fax: 305.673.7254
LOBBYIST NAME: C/1 p
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 add' , once • issue ave - gister -: to lobby •n has been resolved, I am required
to • mediately noti the City Cler s * ice of lob• ist withdrawal in writing.
Signature: Date: