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M IAMIBEACH
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 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 s exclusions. Please ref r to Ordinance 2004 -343 .
Sc .110141 q4 r oej.
NAME OF LOBBYIST (Last) (First) (M.I)
Weiss SerotA Iiel Oa.s o- Cole. J. ,Pio4i:si •0.[.
25025 Pmnce e. Leon 21vl Suite- 700 Gotg( GtL r�L -3(3
BUSINESS NAME AND ADDRESS ? Number and Street) (City) (State) // (Zip Code)
( $5 (2s') 8 - 132.3 e-SCAil nq 141.5A Juw coo
TELEPHONE NUMBER: FAX NUMBER: EMAIL.
Please notify this .office if your contact information ch address, phone, or a -mail address.
1. LOBBYIST RETAINED BY:
W 5 e, 5e TAB
NAME OF PRINCIPAUCLIENT
35 YO /UW 3741 Cot'4' a"d Pot ; J F'- 33/ a
BUSIN SS NA E AND ADDRESS (Dumber and Street) (City) (State) (Zip Code
acs .38 -304. ' 3 , ' tooi a Ada esewicesi4C. co(l
TELE" ONE NUMBER: FAX NUMBER: (Optional) E r IL. (Optional)
Fill out this section If principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST
11.0)Ed101d - bigi agiel; //
50;61 Wcsie r 4'ichis2 Renew
Issue to be lobbied (Describe in detail):
in. C1TY'' ;AGENGIES!JNDIVJDU w ; AWR BE OBBIED:
Pursuant to City Code Section 2- 482(a)(4) include the commissioner cr 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
commencernent 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
Ai) Ol'yar CUnu mP*1�erf 4,61
Pursuant to City Code Section 2 -482(g) Every registrant shall be required to state the extent of any buqfiliss, financial, familial or professional
relationship, or other relationship giving rise to an appearance of an impropriety, with any current cit ddudT18s tutracity personnel who is
sought to be lobbied as identified on the lobbyist registration form filed. 17 3,3
, 1(
Sec 2- 482(g) Any Financial, Familial or Professional Relationship 3e
: 6 . " 7nr /loa
A
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE. (Required) )j. -500 A O W
B) PRINCIPAL'S 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 vou 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 L;J No: Are vou 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, all register with the clerk as required by this section but, shall not be required to pay any registration fees.
❑ Yes No: Are vou 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 RECEIVE • IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EN IF THE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature of Lo is
I do solemnly swear that all of the foreg ' g facts are t e and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Mia ' Beach Ci ode a all porting requirements.
Signature of Lobbyist:
Signature of Principal /Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
❑ Produced ID ❑ Produced ID
Form of Identification Form of Identification
ersonally known (Lobbyist) ❑ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami -Dade State of Florida, County of Miami -Dade
Sworn to an subscribed be •re me Sworn and subscribed before me
This �� da • u 201 �— RAVEL0 This day of 2011
ii i MY OMISSION #EE032167
( A / EXPIRES: November 21, 2014
Sign- • r MP : 4 /Sta = of FIr: ': ,11; e« Th ro► f '" : ture of Public Notary — State of Florida
Nota �? T' • • obb is s signature o ization of Principal's signature
TO BE COMPLE BY Clyt%ELERK'S ST FF N Y�
Annual Registration fee: 1 I Yes.[ ,IN° Amount Paid $ MCR # ��.. [ Date Paid
Lobbyist Registration Fonti received a nd verlfled by
F: XCLER\$ ALLIaFORMS\ LOBBYISTFORMS\ LobbyistAnnual ltegistrationForm.doc, Rev 1/11/2 11 ,
I
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE (Required) $ 4 Ov,
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(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':
i es ❑ No: Are vou lobbying on a oresent or pending bid for goods. eauloment or services. or on a present or oendinq
award for goods. eauloment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
117-No: Issues
A Yes IJ No: Are you lobbying: on a oendina 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 all register with the Berk as required by this section but, shall not be required to pay any registration fees.
D Yes No: Are vou reoresentina a notfor-orofrt corooration 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
. - _ ti,. _ _ si,E. 1 , _ . 5 • 5 LLL : _ _ • . 1 _...,,:.TION RECEIV • IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED N 1 THE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD. r
4
Signature of Lo •
1 do solemnly swear that all of the foreg g facts are t e and -. = and that I read or am familiar with the provisions contained
In Section 2-482 of the Mia ' Beach C ode a ali ' :7 quiraments/
Signature of Lobbyist 1. i
S
1 , 1 , 11"ilir
ignature of Principal /Client
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
❑ Produced ID ❑ Produced ID
Form of Identification Form of Identification
ersonaily known (Lobbyist) 5 Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami -Dade State of Florida, County of Miami -Dade
Sworn to anial subscribed b - • re me Sworn and subscribed •,,_� =��, • =
This /1 da • v 0 20 — [ SARIIAFFilA\IE:IA This .. da of Mori CA, :LOS MANGUAL
d ) / AIYOOMMEIS10N11EE0Rt6f i .� _ `, � I •._ MY COMMISSION # DD87619; ' z EXPIRE& November 2t, 2014 „_ "
Sign- I If t ! n : of FI l ice. Y `' a dttrdnoseyP' & " L a1 " of P • is •
— cif: ;13-°153 a EXPIRES March 31, 2013
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Note .c signature Zatlon P11 I • : I'8 S • r1:.: " FlondallotaryService.com
iiil TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
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mi AM I BEAC H
City 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: (1? )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
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.
0
Signa e: Da :