Gerald K. Schwartz - Doug Bangel Cameo's B EAC H
AS
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
activ' 'es. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST: (Last) (First) (M.1)
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State). (Zip Code)
�.s X73 -/io � G 7� - sus -r��'"�4��/��`f��• e�-�-n
TELEPHONE NUMBER: FAX NUMBER: EM IL:
Please.notify this office if your contact information changes:address, phone, or e-mail address.
I.
LOBBYIST RETAINED BY:
NAME O PRINCIPAUCL ENT:
11(yr
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:
II SPECiFIC,LOBBY_ISSUE;
Issue to be lobbied(Describe in detail):
III.CITY ACENC.I.ESZINDIVIDUALS -0: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,s
tating the eneral nature of the,sub'ect contractual relationship.
Sec 2-482(a)(4) Full Name of individual and Contractual-Relationship(Explain) YES 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 professional
relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner or city personnel who is
sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2-482(g) Any Financial, Familial or Professional Relationship
C.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A; LOBBYIST D!SCLOSUR (Required)
Bi PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMP=NSATION):
(Required).
The following information must be answered: I ,
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 Estate4:,
Development 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?1.
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
N : 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 RECEIVED. IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD,
grater o`L ��yiS:
119/ V
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 Mia ch City Code and all repo uirements.
i'
Signature of Lobbyist:
Signature of Princi al/Client:
Vt. LOBBYIST IDENTIFICATION: 'PRINCIPAL'ID TIFICATION:•
Produced ID5(03Z�o?71' 3 1oducedID
Form of Identification Form of Identification 11 1 1 al ❑ Personally kn ; iahcipal)ISABELSATCHELL
Personally known (Lobbyiq )),.'tY;„P�r'y P��'�.OMMISSIONgDD879891
r•=v aF; ISABEL SATCHELL •: n-
(` MY COMMISSION#DD 879891 a p"' ' April WIRES: nl 13,2013
VII.
SIGNATURE AND STAMRiQ,..,. • ARIPXPIRES:April13,2013p,';; ;5' g�Katlrhru Notary PuWicUndetwrlters
Bonded Thru Notary public Underwriters
State of Florida. County of Miami-Dade r State of=lorida, County of Miami-Dade
Sworn to and subscrib before me Sworn and subscrib o before me.
This I`� ay of . 2011 This'1 day of "2011_Psa�
S
Signature of P blic Notary— State of Florida Signature of Pu is Notary Sate of Flonda
Notarization o Lobbyist's sigpiature Notarization of Principal's signature
TO BE COMPLET D BY CITY CLERK'S STAFF ONLY
Annual Registration fee' I Yes [ ] No Amount Paid S ! MCR# 31 3F 7 Date Paid
Lobbyist Registration Form received and verified by:
=0RM.5Z1L0i3o"ir Annu-+'Feamtration Form-do: p Revised 1/11/2011
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, Wwv,'.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeochfl.gov
Tel: 305.673.7d11 , Fax: 305.673.7254
LOBBYIST NAME:
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, 1 am required to
immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
ignature: ate: