Ralph Choeff - Glen Havensteinl ,
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tb r MIAMBEACH
, . City of Miami Beach Office of the City Clerk
1700 Convention.Center Drive, Miami Beach, FL 33139
;LOBBYIST REGISTRATION FORM- , , F:„.,'
Lobbyist means,all persons employed or-retained; whether paid or hot, 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.
NAME OF LOBBYIST (Last) (First) (M.I)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip'Code)
( 4 8 3 3 e CAS). Z-42g 2 rt,Qe�Ce c ki (evy . caw►
TELEPHON NUMBER: FAX MBER: EMAIL.
Please-notify this office if your contact information changes: address,phone, or-e-mail address.
I. LOBBYIST RETAINED p
BAY °
GLEP 'IWO I Sgyl p vl
NAME OF PRINCIPAL/CLIENT
13 fP1D-12 �Jc- qo p Q , �J C1b. ° 3�3 p 9
BUS N SN E AND ADDRESS
(Number and Street) (City) (State) (Zip Code)
116 - l Cool C2c°rd'S .v3 .-CIA uG4JS-PthV e., mut-4,
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL. (Optional) ,(y1
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
n.SPEGF:ICioBBY ISSUE: P9-0 . 4'2'6)4 SMAul l‘"`'' t° (2-€SiC18.14 c,€ +lLca,r-J IFtia42.
d Ca. Q iv '- i• u[1 &4 , . L S_T LET COJ&1416 .
Issue to be lobbied(Describe in detail): qes F; ° , °-�. 43 S ;1`*�":.
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(0(4)Full Name of"Individual and Contractual Relationship•(Explatn) o YES NO
,;title of person to be lobbied ", • --4
' ii.)I
. rr
Pursuant to City Code.Section 2-482(g)Every registrant shall be required to state the extent of any business,fin. cial,-Wmilial r professional
relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner amity personnel who is
sought to be lobbied as identified on the lobbyist registration form filed. g �'� _
Sec 2-482(g)Any Financial,Familial or Professional Relationship rte'" Ns
Ag cthz€c-r To 0Wt s - wosi sk„►.1 Ate, 1 •
14 .
IV DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER)•
A) LOBBYIST DISCLOSURE.(Required) Y7- ' ,. - 1 QE, 4it(sc,/,tr,„ .
B) PRINCIPAL'S 'IS�C�L/O,,S`UR-'E�OF OBBY S�j CO P •S TIO ) S,9in +
(Required). ���4�61�- , �t Sr' 1��./�- �c�1 �,, 1 �"��!Q�� �v ��,`
The following information must be answered: 4, ,�r`J Y` - 63rd`MA C�� 1�.-,(t �IJS- 2 -t(44.3
9
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By.Lobbyists On Procurement
Issues"
❑ Yes o. Are you lobbying on a present or pending bid for goods,equipment or services,or on a present or pending
)6N
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 VNo: Are you lobbying on a pending ap•lication 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 o: 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 SH• -UBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES, AS WEL C. PENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEME■ SHAL BE FILED EV N IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PE: •D. 1
Signaf re of L.iris
I do solemnly swear that al - - fora•oing facts ar-true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 oft - f iami Br ac • Co.: and .11 -.0 -g requifements.
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Signature of Lobbyist:
I�
Signature of Principal/Client: ;:I° ; ' .''....e.... ,--- -fJ
VI. LOBBYIST IDENTIFICATION: PRINCIPAL.IDENTIFICATION:
'raL-It• Li-Ce.P5e-.)
;2Produced ID G(b 720-56- -CD 4Produced ID br1 ��
Form of Identification Form of Identification
Ji�k,;�IS; ISABEL SATCHELL
❑ Personally known ( •t4s$j MMMY COMMISSION iDD879891 - ❑ Personally known(Principal)
.:.� ` EXPIRES:April 13,2013
F c,,r' Bonded Thru Notary Public Underwriters
VII. 'SIGNATURE AND . Y'
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn to and subscribed before me Sworn awl subscribedrbefpre me
This o' a •ay of (_-, , ' 2011 This /O day of NOY , 2011%, _r
(111,_c) /Signa.- of •ublic Nota ry-State of Florida Si ature of Public Notary-State of Florida
-Notarization •f Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAF ONLY
Annual'Registration fee: "[ ]Yes[ ,]No Amount Paid.$ ...50-° MCR# 2 3 Z/ Date Paid /�/2. //
Lobbyist Registration.Form"received and verified by .J` /L-(../- u 4 ---
F:\CLER\SALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Forn:.doc Revised 1/11/2011 •
,5/fr(//� i'/"V
fAf\/\ BEACH
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: P4. C..032cP
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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