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Tucker W. Gibbs - 60 Collins Association, Inc. nn e' r M IAMIBEACH � pp G City of Miami Beach Office of the City Clerk Ui t)° 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. 446,65 vti TUCKC4 NAME OF LOBBYIST (Last) (First) (M.I) 3?2s & TDfii4 cr adorn/7 (.,4/c; / f - z - 33i3.3 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 34r -44Ie-tvedv der- LAT- 0773 I242U0_ 1.1e b4'j • cowl TELEPHONE NUMBER: FAX NUMBER: EMAIL. Please notify this office if your contact information changes: address, phone, or e-mail address. I. LOBBYIST RETAINED BY 40 / COLL /Ns AS1 a c /4 17, Ale NAME OF PRINCIPAL/CLIENT (0/ CAL/NJ 4JJd?IATIdal .,u. 7D/ 4' r : sf< <d Mom/ 33,a4 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 aaorporation, artnership or Trust [Section 2 -482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY 4 /mill Na/ d PkJ /de„ r • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST N/A - Pk NW-,/1't • "Weir P1A5,AJ II.SPECIFIC LOBBY, ISSUE; '1-53 6A-14 Ail 4$12 ,, jf 4 / 4 0,09 4t2 Frig 4/) 2.40a Issue to be lobbied (Describe in detail): ul. CITY AGENCIESIINDIVIDUALS 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 Plea/„ ,.zwi j ,6 ' Die6 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(g) Any Financial, Familial or Professional Relationship S.�a T13 k I13 JJO WdAig 81 :ZI 6Wd sZ tiff I IQZ a3M -3338 IV DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER). A) LOBBYIST DISCLOSURE: (Required) tidvRLy _ B) PRINCIPAL'S DISCLOSURE (OF LOBE I T COMPENSATION): (Required). i tte..- JUN' 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 ril 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 al 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 W 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. A Signature of obby 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. o • Signature of Lobbyist: •�,� 4,r • Signature of Principal /Client: ' / VI. LOBBYIST IDENTIFICATION: / PRINCIPAL IDENTIFICATION: Et Produced ID r(( L [ 44- G 17) Ili c3 t O -' 0 Produced ID Fb L -lA/ ?- 0 G Y 224- O. Form of Identification Form of Iden iffication known (Lobbyist) ��` N, a BE AU C // "/ ❑ Personally ( Y ) 0 Personally known (Principal) �P /y N pT\SSION ' .� i VII. SIGNATURE AND STAMP OF N 29,207•'>' ; ``�NNIIIIII// //j / / // BiT ..1.. QQ '7 P /- _ ` ��0BEAUC 1/4 State of Florida, County of Miami -Dade •• N i* _ �,NASSI �. , tY _ — State of Florida, County of MiarDd�o \ 29 ,po Z Sworn to aanq subscrib -. before me o #DD 983701 ; a Sworn andbscri • - before rge . u,'� This , a 0 i1 day of , 2011 , p a, s a nded s e o� This _day • _ / _ � I / i i, / e UC, S ?A� ��. � � ` �_ _ i i ✓:r P 0983701 a� gnature of Pu. jr' Notary — State of Fl , rida / / NIH11110 0 ` Sign ture of Publi rotary — State of Flon'' • ' oQ� Notarization of Lobbyist's si ature Notarization of Principal's signature ' ; TA / / /Hlllllq! \! \ � ` ! O BE COMPLETED BY CITY CLERK'S STAFF ONLY � �6 Z Annual Registration fee: [ ] Yes [ ] No Amount Paid $ MCR # U Date Paid 4 " `/ Lobbyist Registration Form received and verified by: I 1 . ' F : \CLER\$ALL\aFORMS \LOBBYIST FORMS \Lobbyist Annual Registration Form.doc e r Revised 1/11 /2011 MIAMIBEACH Cit 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: W 71)61CLz'L Gi,5 t 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. i Signature: Date: MIAMIBEACH M1AMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139 www.miamibeachfl.gov DEPARTMENT - City Clerk' Office Tel: 305/673 - 7411 Fax: 305j673 - 7254 City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov DEPARTMENT - City Clerk' Office Tel: 305/673 - 7411 Fax: 305/673 - 7254 ANNUAL LOBBYIST REGISTRATION FORM Name: W ?UCK©t. G/1 ANNUAL LOBBYIST REGISTRATION FORM Business Name: in/. 71/6 - Gag. gx. Name: Address: RD, gdK ala Business Name: Phone: 3f = Address: Email: ivaefe L.& ale • 4.11, Phone: If more than one Lobbyist, please list: Email: 1) If more than one Lobbyist, please list: 2) 1) 3) 2) 4) 3) 4) MCR #: Amount paid: Date paid: MCR #: Processed by: Date: Amount paid: Date paid Processed by Date F \CLER \LOBBYLST \tobbyistAnnual Registration Form doc F \CLER \LOBBYLST \LobbyistAnnual Registration Form doc