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Beth C. Sobol (Ferrero) t\t A BEAcH -` = 1 V \ I I City of Miami Beach Office of the C Gt k ' / / -- 1700 Convention Center Drive, Miami Beach, 3313 LOBBYIST REGISTRATION FORM rt• Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to $films� ragi�the passage, defeat or modification of any ordinance, resolution, action or decision of any commissioner; any action, decisionrtfkcommendation of the City Manager or any city board or committee; or any action, decision or recommendation of any city personnel during the time peric d 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 obbying activities. The ter "Lobbyists" has specific ex lusions. Please refer Ordinan 2004 -3 ` Lfetk-Q5-0 NAME OF LOBBYIST: (Last) (First) (M.I) C B 1( \i■-) etA BUSINESS NAME AND ADDRESS Number and Street) ) (City (State) (Zip Code) (73 3 ay TS4 5o\DA ��ar r� TELEPHONE NUMBER: FAX NUMBER: EMAI : Please notify this office if your contact information changes: address, phone, or e-mail address. I. LOBBYIST RETAINED BY: NAME OF PRINCIPAUCLIENT: '— 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: • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ILSFECIMC'LOBBY 4ssup . ‘),(k9 \/.), • Issue to be I• • •ied (Describe in detail): III. CITY .AG'ENCiES!IND.JVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2- 482(a)(4) include the commissioner or personnel sought to be lobbied, and whether the lobbyist las entered into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding su .h 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) Y S NO title of person to be lobbied Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extent of any business, financial, familial or • rofessional relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner or city pers • nnel who is sought to be lobbied as identified on the lobbyist registration form filed. Sec 2- 482(g) Any Financial, Familial or Professional Relationship IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR ;%. OTHER): A) LOBBYIST DISCLOSURE (Required) �(\ `Q._ B) PRINCIPAL'S DISCLOSURE (OF LQ„QBYIST COMPENSATION). (Required) '+ N. ,n 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 LTNo: 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 CJ 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, shall register with the clerk as required by this section but, shall not be required to pay any registration fees Des ❑ No: Are you representing a not - for - profit corporation or entity without special compensation or reimbursement. . • • V. SIGNATURE UNDER OATH: I • 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 I, THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL = E. FILED VEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERK , r Sig - r re , fob I do solemnly swear that all of the fors , • ing 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 �, ; ode : nd all reporting re uirements. ; Signature of Lobbyist: "" t � ��`��. Signature of Principal/Client: � �i '� Si � \ 9 P �= VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Ei Produced ID r 1 r' V S �‘ L C-( Produced ID 1'` 1 ems' • .Jr I ✓`ct S � I (, -( S C Form of Identification Form of Identification ❑ Personally known (Lobbyist) ❑ Personally known (Principal) 29 ���NIIiliiiiiii,�^ .��`�1111illlly/ VII. SIGNATURE AND STAMP OF NO YBEAU ,,,�. �� n. � � \. . ..... • ... '' te. \� P BEAU�y %,; State of Florida, County of Miami -Dade Z ..•_, 0 , 2 F- i , g • State of Florida, County of Miarr Alts** • � O • ``o • * P Q '� �,• Sworn an subscri -d before re : —> , 2o z� 9 N '. Sworn to and subscrib - . This G, day of r • before me _ , 2011 e • 701 . * _ This !� day of _ �, . l'�1 • Ili / l l ± . / __ _� : ti #DD 98 • � O� li � 2 . / QQ l . _ i �� - 9• ' of Bond 1h \ .. 2 /f . ° i ature of Pu• Pc Nota State of FI• - ..o • �, � i ature of Public N. State of Flon.`� . • $ � ; : Notarization o ' obbvist's signature i / //l C, sTp .: ,0 Notarization of Principals signature i b i '&81 ;,• • gT pt.p e `�' . 111iitt9 / /ilPtgpllil0?�� TO BE COMPLETED BY CITY CLERK'S STAF ONLY / Annual Registration fee: [ ] Yes ] No Amount Paid $ MCR # /0 A Date Paid N / // d Lobbyist Registration Form received and verified by: . ! : - e /F ' ' _ - r F : \CLER \$ALL ikaFORMS\LOB YISr FORM \Lobbyist Annua Registration orm.doc Revised 1/11/2011 if/V- fa 4' 74— . c } 1 ,©// ,p City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov C /. "S , - .N x CITY CLERK Office CityClerk @miamibeachfl.gov C'< el/ e T 305.673.7411 , Fax: 305.673.7254 C c - X /) LP ti. <?( / 0 , ‘1 ,..,L \1 . IIINA LOBBYIST NAME: " AS& * v � , , 2 I I II I I I II I I I I I P in' I) 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 req.iired to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. r \ , �40 0 '�` r 1� Signature: , Date: