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Randall Hilliard - Beach Towing Services �u j // • . i . tiA p A 1 A t., A, i City of Miami _Beach. Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139. F 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. Hilliard,' Randall NAME OF LOBBYIST: (Last) (First) (M.I) Hilliard Consultants; 2074 W Tndiantown Rd., #202, Jupiter FL 33458 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)' 673 =5353 .(305) 673 -5352 rhilliard @aol.com : • - TELEPHONE NUMBER: _ FAX NUMBER: EMAIL: A , Please notify this office if your contact information changes; address, phone, or e-mail address. - • i. L RETAINED BYs Beach - 'towing Services, Inc. • NAME OF PRINCIPAL/CLIENT: - Beac Towing Services, Inc . 1349 Dade Blvd . ', . Miami. Beach FL 33139 BUSINESS NAME AND ADDRESS • (Number and Street) (City) (State) (Zip Code) (954) 465 -9533 TELEPHONE NUMBER: • FAX NUMBER: (Optional) EMAIL: (Optional) • • Fill out thissection if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER OR BENEFICIARY: IDENTIFY ALL PERSONS HOLDING, HO President DING D R ECTLY OR INDIRECTLY, IRECTLY, A,5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,.. PARTNERSHIP OR TRUST: ,, ,Jose Rodriquez Representation concernin land use issues in I -1 Light n.SPECIFI C ' LOBBY ISSUE: P concerning Industrial District as well as 'towing and storage uses throughout, the City of Miami . Beach. - issue to be lobbied (Describe in detail): III. CITY AGENCIES /INDIVIDUALS 1r0 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 per 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 Individlual and Contractual Relationship (Explain) YES NO title of person to be lobbied • City Manager, City Attorney and Administrative Staff: N/A X Mayor . Matti Bower and Commissioner Deede Weithorn: Consuit Serv ` X All other Comitnission and Staff - - 11/A X Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state 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 is . - sought to be lobbied as identified on the lobbyist registration form filed.: Sec 2- 482(9) Any Financial,: Familial or Professional Relationship ``I`i i . 40 s u - , - ) , Vendor to the Mayor and Commissioner Weithorn on - constituent serviCe � : . ,Z ' ' ,d . 6i-- AW.I }Oz . µ� x _. r „�` • • . ":, ,- V . s, r*t • IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): ; . ' A) LOBBYIST DISCLOSURE: (Required) $2 , 5OO.00"'�per month B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): $2,500.00 per month • (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 ": 0 Yes Di No :, Are you lobbying on a'present or •endin • bid for • oods e • ui • ment or services or on a • resent or • endin • 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 f 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 C ity 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 entitywithout 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 HA VE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. - • d . l Signature of ■ Lobbyist - I do solemnly swear thatall of the foregoing facts are true and correct and that I have read o'r am familiar with the provisions contained in Section 2-482 of the M`- taw ch City Code and all reporting equirements. (....2 ...............___ Signature of Lobbyist: 'fr' • Signature of Principal /Client`�,l • VI. - LOBBYIST IDENTIFICATION: Nw u, -PRINCIPAL IDENTIFICATION: ' � z ❑ Produced ID I ,, , .1 D Produced ID • • Form of Identification ■ 1, — ∎ 4' Form of Identification d = ID V) ' c1( personally nown (Lobbyist) f' J +- y ( y ) j P ersonally known ( Principal) - . 1 f .. 4 VII. SIGNATURE AND STAMP OF F. NOTAI -- 1 p l ° N 'N 4 " Z a) .co 'ft .,. C U. :: a State of Florida, County:of Miami -Dade ; in g State of Florida, of Miami -Dade ". t c ai. This n t •a of ed bef. e me $ Swor an d su cribed before me :. z , a Sworn t.. nd ubscribed � , y -if ,.2011 " I This (, d ', of , l f` 2011 ' ' ',Pr / r ' 1 Signat re of Pu • I ..-' Sta e . e lea N Signature of Publ '► • . ry - State of Florida a Notarization of Lobbyist's si ii Lure Notarization of ; rincipal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ] .Yes [ ] No Amount Paid $ 4 " " ` MCR # f0 ' c L Date Paid ! / Lobbyist Registration Form received and verified by itillai' FA _ ` L .MS \3 O �+ $, j k /� /. Revised 1 /11/2011 e �a". t, � � :� 2. 3� ? 5.1.s ..o #".: °s$ £"� " >�: g.�= k�t.. .5 Ski. >� .a. x'I : \�a s'�i'.'� "�. e�`� "��, � ' - t �jC y_ # City of Miami Beach, 1700 Convention Center Drive, Miami Beach; Florida 33139, -www.miamibeachfl.gov CITY CLERK Office CityCIerk @miamibeachfl.gov Tel: 305.673.7411 ; Fax: 305.673.7254 ' . LOBBYIST NAME: Randall Hilliard 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 re 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, 1 am required • to immediately . notify.. the City Clerk's Office of lobbyist withdrawal in writing. Qa2SL_. Signature: • Dat.: • • • • • • •