William R. Thomas - David Aronow, Esq. �, ►a�is Ott b riVO
MIAMIME-ACHI
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
activities. The term"Lobbyists"has specitic 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) (Stale) (Zip Code)
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TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify thiS'Office if your contact information changesr'address,'piiant?,6'a mall address:
I. LOBBYIST RETAINED BY:
_(DOiid Araew W
NAME OF PRINCIPAUCLIENT:
laCoo St 331�r'
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 OBIBY;ISSUE:
(we S,S, w t
Issue to be lobbied(Descilbe in detail):
III.CITY AGENCIES11NDIVIDUALS 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 ci to the present date,stating the eneral nature of the subject contractual relationship.
Sec 2482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to be lobbieA
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Pursuant to City Code Section 2482(g)Every registrant shall be required to state the extent of any business,financial,familial Drprofilnl na i-]
relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner or city personngswho is
sought to be lobbied as Idontifled on the lobbyist registration form filed.
Sec 2-082 An y Financial,Familial or Professional Relationship1
C rrT cn
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHERJI:
A) LOBBYIST DISCLOSURE:(Required)`
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): '
(Required), lJ
The following information must be answered:
1). . . .. Pursu.ant.to Miami Beach City Code Section.2-488.Entitled"Prohibited Campaign.Contributions By.Lobbyists On Procurement
Issues":
❑ Yes allo: 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
Development Issues":
❑Yes d No: Are Vou lobbvinq 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-far-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 Vlo: 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 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.
L
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 Code and reporting reyuireMg Is
Signature of Lobbyist: `
Signature of Principal/Client
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
❑ Produced ID ❑ Produced ID
Form of Identification nFit , Form of Identification
= L:
personally known(Lobbyist) erson aliy known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY: m
x n
State of Florida,County of Miami-Dade . • State of Florida,County of MIam1-Dade Swom to d subscribe fore me Swam and subscribed efore me m This day of ,2011 T is day of t)b� o m D D O 3 Q z 0
Signature o ublic Notary—State of Florida Signature of Public Notary—State of Florida d `� z Notarization of Lobbyist's signature Notarization of Principal's signature m rn TO BE C CITY CLERK'S STAFF ONLY j r
e MC Anntai Registration fee ye No Amount Date Paid
Lobbyist Registration Fo received and verified.py
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\LobbyistAnnual Registration Form.doa ., / Revised 1/31/2031 .'.:.
P0IAMI B EA
City of Miami Beach,1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office CifyClerk @miamibeachfl.gov
Tel:305.673.7411 ,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, I am required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
(7 l�
Signature: Date:
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' Mis ash Receipt
CI O,,i~MiAMOS CH
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No.
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❑ Cash 17 Credit Card Check# $
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Address
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(THIS INFORMATION MUST BE COMPLETED) Office of Finance Director
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- Account Number.
Preparer: Dept: EXT• b y