Jeff B. Friday - Film Life, Inc. 02- 22- 11;17:46 ;filmlife 913056737254 ;16463752059 # 2/ 4
tri MIAMIBEACH
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 Clty
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 foreseeabiy 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 terns "Lobbyists" has specific exclusions. Please refer to Ordinance 2004 -3435,
NAME OF LOBBYIST; (Last) `rir-'"V (First) 'jeer_
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
l NA L4= r iNC. fore of - ri2z 114 t •23 ,-cx%•∎•. / o , hlewDorf ,
TELEPHONE NUMBER; 201. FAX NUMBER: 6 S. 205cl EMAIL: ,ie feetb. l.,,l, + ?. c�M
Please notify this office If your contact Information changes: address, phone, or e-mail address.
LOBBYIST RETAINED BY:
F,L+� l if =r✓ r �tvc . / J E F-r (P62CS��<'tti'i' 2 Cc'C�)
NAME OF PRINCIPAUCLIENT:
ITV C . ( 6,). 2 N no&-c k t N (.00 ■
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER; Z.01. 2 o4•64 ars FAX NUMBER: (Optional) EMAIL: ( Optionsl)
Fili out this section If principal is a Corporation. Partnership dr Trust [Section 2 - 482 (c)] •
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ;:re Pr-
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST': 5
n.SPECIFIC LOBBY ISSUE:
15 an n L � / vwz -n'Con e
Issue to be lobbied (Describe In detail):
III. CITY AGENCIES /INDIVIDUALS TO BE.LOBBIED:
Pursuant to City Code Suction 2- 482(a)(4) include tho 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 tho clty to tho prosont date, stating the 9enerai nature of the subject contractual relationship.
Sec 2 - 482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES NO 1
title of person to be lobbied
C - N
Pursuant to City Code Section 2.482(g) Every registrant shall bo required to etete the extent of any business, financial, familial or professional
relationship, or other relationship giving rise to an appearance of an Impropriety, with any current city commissioner or city personnel who '' +s
sought to be Iobblod as Identified on the lobbyist registration form flied.
Sec 2482(g) Any Flnanclal, Familial or Professional Relationship .
Pro, q a. 1, r, •�
•
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER): c
A) LO88YIST DISCLOSURE: (Required) N (H o i t t- C Y' - 11. i(./i-e- (O &rj �- - Co.
Li
(.1
B) PRINCIPALS DISCLOSURE (OF LOBBYIST COMPENSATION): NOivE
(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 ': '
1 Y' • % •• a - • . • • • z, on a .resent or •endin, bid for ;Dods e.ui. .r .. , or on a •resent or .endins
award for goods. eaulDment or service?
2) Pursuant to Miami Beach City Code 2 -490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues ":
QYos �NO:Are you lobbying on a pending application for a Develupmeint 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, shalt register with the clerk as required by this section but shall not be required to pay any registration fees.
!�J 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 WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EV HERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PEf310P,
Signature of Lobbyls
I do solemnly swear that all of the foregoing facts are true and rrect an that have ead or am familiar with the provisions contained
in Section 2 -482 of the Miami Bea City Co nd orti requirements.
Signature of Lobbyist: \ ` i. � ' 1' (flol
Signature of Principal/Client: \N ,�� 1 1- I^ ( 0
VI. LOBBYIST IDENTIFICATION: �\\� ` '� - PRINCIPAL IDENTIFICATION:
Produced ID IJzw �aa$t• A,f, �,„�1 I.,a/,,s< _ Produced ID l\-6-4, -16tC A4,ElAn.�,L „A< Form of 1 entificat i on Form of Identification
❑ Personally known (Lobbyist) 0 Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOT
),ICr,,•/,n,� e,,,, K EVANS J LEGROS I : t,,�,M. Vu.k t ., JJjEGROS
State of Flesiija, County of ARY PUBLIC STATE OF NEW YOH i State of Florida, Ca i .i pft ATE OF NEW YORK'
Sworn to and subscribed before me NEW YORK COUNTY ( Sworn and subscri • ed beforENEW YORK COUNTY
This 44. day of 2011 LIC. #021E81328 { Th �d Q d .f < e p. 62LE8132876
COMM. EXP. AUGUST 29, 2013 _ COMM. EXP. AUGUST 29, 2013
ignature of Public Notary - State of W t " X Signature of Public Notary - State of Fierifie !Jaw Ya4 h
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY Cirr cLERK'S STAFF ONLY
Annual Registration fee: [ ] Yes [ ] No Amount Paid $ MCR # Data Paid
Lobbyist Registration Fonn received and verified by:
F: \CLER \$ALL \aFORMS \LOBBYIST FORMS \Lobbyist Annual Registration Form.doc Revised 1/11/2011
•
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M
City of Miami Beach, 1700 Convention Cenlcr Drive, Miomi Beach, Florida 33139, www.mlamibeochfl.gov
CITY CLERK Office CilyClerk @miamibeachfl.9ov
Tel: 305.673.741 1 , Fox: 305.
LOBBYIST NAME:
J� ✓- k ) f\-
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 Miarni -Dade
County Commission on Ethics and for code violation evaluation.
In addition, once an issue I have registered to lobby on has been resolved, 1 am required to
immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
%OIL 02/2:2
Signature: Date: