Arthur H. Hertz - Orange Bowl Committee .. [ 7 \ IoJ Ron T PRO -
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City of Miami Beach Office of the City Clerk ' 1 -'"
1700 Convention Center Drive, Miami Beach, FL 33139 p
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 engagd in lobbying
activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004 -3435.
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NAME OF LOBBYIST: (Last) (First) (M.I)
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BUSINESS NAME AND ADDRESS I (Number and Street) (City) (State) (Zip Code)
DS S r - / 3 3 L S s -1 Kg ( 2 1 -) abenc . ffo eil -e0/71
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes: address, phone, or e-mail address.
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I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL /CLIEN
Df Com H to / <3 60 /240 - 22 111 c 7`' /Ma/pi takes 330 (,
BUSINES AND ADDRES (Number and Street) (City) (State) (Zip C de)
3os - 34I Ll �?� S 3os-_ 3�/- '/779' rcc..rr, ocar -'w1. or
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: r 1' G Pot S
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY ISSUE:
Issue to be lobbied (D cribe in detail):
III. CITY AGENCIES /INDIVIDUALS 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 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 CI d
n
Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extent of any business, financial, familial grofeonal
relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner or 64'4 perepneLvyl' o is
sought to be lobbied as identified on the lobbyist registration form filed. �.
Sec 2- 482(g) Any Financial, Familial or Professional Relationship T �...•
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE: (Required) 011/2'.
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). f) 0 ,,
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 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
Dev pment Issues ":
❑ Yes 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 opppsition 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 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 CEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED E IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD. /—
Signature of Lobbyist
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 Cod d all reporti requirements.
Signature of Lobbyist:
Signature of Principal /Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
❑ Produced ID Produced ID Ce.15
Form of Identification Form of Identification
.,g Personally known (Lobbyist) ❑ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami -! + _ Y f LINE POTEAU
Y State of Florida, Count/ bi':Mia i- e
Sworn to a • ubscribed before rp Sworn a d subscrlpe`d; �"" ' r �A OMMISSIO�i t e� :' X389
�� � � . s�` oe Notary Public State of Florida Thi )
This Ae • ay of / 414 Debra A Mendez day of .': • E EIS Novembar 17 2012 2
` a t My Commission DD766607 .1 953 FioridallotaryServ►ce.com
'�oF 0. 5P Expires 03/10/2012
Signature r : is N• a ' — Stat- nature of Public Notary — State of Florida
Notarization of Lob , yi 's signature Notarization of Principal's signature
TO BE COMPLETED Y CITY CLERK'S ST FF ON Y •
Annual Registration fee: [ ] Yes [ ] No Amount Paid $ / - MCR # d - 0 ! Date Paid •
Lobbyist Registration Form received and verified by:
_4 ,& �k!` a ' p i k "9 f FORMS $Lth ts: s"`!'" rio ai .d,ilstfail n "orm..0 c 174;e Revised sec! S /t.Y /2,01
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et MI A MI BEACH
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: Heilz-
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.
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Signature: Date: LI
Page 2 of 3
Subject: FW: Lobbyist Registration - Orange Bowl Committee
Silvia:
It was a pleasure speaking to you this afternoon.
I was able to contact my COO, Michael Saks, and we are OK with Mr. Hertz, Mr. Saks, and Mr. Nasca are serving
as Orange Bowl Committee Principals AND Lobbyists.
Please let me know if we are able to process the Lobbyist Registration forms as is. I'll go ahead and call you to
ensure that these forms are confirmed.
Thanks in advance,
c risti:n.a m. ra ios partnership services & fulfillment
orange bowl committee 1 14360 nos 77th court I miami lakes, fl 1 33016
tvor'k : 305-341-4725 I fax 305-341-4779
email: crarr7OS(a)orafgebowl.org www.orangebowl.org
EXCELLENCE. ORANGE,
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Jorn us on FaceSook and Twitter
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http:// www .facebook.com /theorangebowlobie
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From: Prieto, Silvia [ mailto :SilviaPrieto @miamibeachfl.gov]
Sent: Wednesday, September 07, 2011 2:48 PM
To: msaks @orangelowl.org; jnasca @orangebowl.org; arth @wometcoent.com
Cc: Hatfield, Liliam; Martinez, Maria
Subject: Lobbyist Registration
Dear Mr. Hertz, Saks, Nasca,
We are in receipt of your Lobbyist Registration on the Orange Festival 2011/ 12 VCA Grant.
However, the "Principal Signature" field was left blank, only the Lobbyist fields were signed.
Are you "Lobbyist:" and "Principal" for the Company?
Please let me know because if the "Principal" is someone else, he /she will have to sign the
registrations.
9/8/2011