James R. Boucher - Boucher Brothers Management l C r, MI AAA ' BE AcH
ea 40(
City of Miami Beach.pffice 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 "Lobbyi has specific exclusions. Please refer to Ordinance 2004 -3435.
NAME OF LOBBYIST (Last) A (First) (M.I) (AA 1 qM g i j„
. !`I ! � .I`�l' AO tI20 / . , r ' Z , FC. 53/31
BUSINESS NAME AND ADDRESS (Number a . Street) (City) (State) (Zip Code)
305- 535- $14.1 S05 -531- - 3a .s Rocco 6 1 11 @ a oi•(4 N•
TELEPHONE NUMBER: FAX NUMBER: EMAIL.
Please notify this office if yourzontact information changes: address,, phone, or: -mail address.
I. LOBBYIST RETAINED BY: /f jid /Adu/C A d
NAME OF PRINCIPAUCLIENT /?..91 4 9 ' 2 ) r Li ii o A el i` - ? - 5 lam ?• F 3 3/ 3 9
BUSINESS NAME AND ADDRESS ' (Number and Street) (City) (State) (Zip Code)
10S-535-V77 7 3 S3& - 3t.s 3fotc,of3 11l @ Qollos4
TELEPHONE NUMBER: ` FAX NUMBER: (Optional) EMAIL. (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2 -482 (c)]
a
• 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 - `
IL SP E CI FIC ` OBEY IS S
l.3 60.4,
CAM ��. Ad.v5 PA-n. k
Issue to be lobbied (Describe in . detail)'!;
III. CITY;AGENCIESIINDIVI CBE - LOBBIED:
Pursuant toCity 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 )eneral nature of the subject contractual relationship.
/ Sec 2- 482(a)(4) Full Name of Individual. and Contractual Relationship (Explain) YES I3�.
:title of.person to be lobbied /`
rMflo cell co w, ail ., ,-/ ...
� S I + �,:;
Pursuant to City Code Section .2- 482(g).Every registrant. shall be to state the extent of anypkb +"ties f or professional
relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner or city ersonnel who is
sought to be lobbied as identified on the lobbyist registration form filed. I 0 tl i 1.18 8- fl 1 in
Sec2- 482(g) Any Financial, - Familial or Professional Relationship
to AI 8
f
IV \ 9, DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER).,;. _
A) LOBBYIST DI (Required) j / ,p
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"
I
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 Erititled " Campaign Contributi By Lobbyists On -Real Estate
Develo ent Issues" 1
❑ 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 opposition to any
item, shall gister with the clerk as required by this section but, shall not be required to pay any registration fees.
❑ Yes o: 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.CLE ISIG D'STATEMENT UNDER
OATH LISTING LOBBYING EXPENDITURES, AS WELLAS COMPENSATION r CEIVED, IN THE OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED E THE' E HAVE B N'NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
I
Sign - of Lobbyist _
I do solemnly swear'that all of the foregoing facts are r. ue and or - « and that I ' ave read or am familiar with the provisions contained
in Section 2- 482•of the •Miami Beach City Code and all -porti ; • i /
((�/� , �■
Signature of Lobbyist • I 1 , /
Signature -of Principal /Client: c X__J 1
■
VI. LOBBYIST IDENTIFICATION• PRINCIPAL IDENTIFICATION:
1
❑ Produced ID ❑ Produced ID
Form of Identification Form of Identification
Personally known (Lobbyist) El Personally known
/ - (Principal)
VII. SIGNATURE AND STAMP OF NOTARY
.47. , CAROLINA T ath 1 , t
State of Florida, County of Miami -Dade Statf Flo
y da, County of Miami -Dade •' ; '
* „ , * MY COMMISSION 8 DD 973446 e oy
Sworn to nd subscrib d before me °',mi :. EXPIRES: March 22, 2014 Swor nd subscr, ed .before me ' . .
This day of ,. 2011 %., 0m.�'� c � � � B Btidal , This n day • ! , ...i , 0
c A. , %-ek l A / / / 1 - /
•Signatur of Public Notary — State of Florida ign:ture of Public •tary — State of Florida
- Notarization of Lobbyist's signature Notarization of Principal's
TO BE COMPLETED - BY CITY CLERK'S - STAFF ONLY l
Annual:Registration fee: [ ] " ,]'No Amount'Paid $ �'S0.' MCR # �/ U ' I Date Paid ` / �/ g ///
Lobbyist. Registration Forni; received and verified -by: - ,
F:\ CLER\ SA LL \aFORMS1LOBCYIST.FORMS\Lobbyist Annual" Registration Form,doc - _ .1 •evised:) /11'/.2011
■
I
4 4
'CA § \`,.
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: Ctti( Q g
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 have registered to lobby on has been resolved, I am required to
immediatel .otify the ity Cle 's Office of lobbyist withdrawal in writing.
/2/ 7 / /f
Signature: Dat
| '
1
'.
\ S.'
I i ' |
' |
. ~^`
- ^ �
! •
. . � .
. �
| r