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Jennifer L. Kuzler - Ignacio Dreomuro 1110'0/2012 14: 17 2125434255 ARTDIRECTORSCLUB PF;c5E 02 h� j� N�1A&/3BEACFf ' . . . , City of Miami Beach Office of the City Clerk 1700 Convention Center Drive Miami Beach 1 > F L 33 39 I LOBBYIST REGISTRATION FORM Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the pas,age, defeat or modification of any ordinance, resolution; action or decision of any commissioner; any action, derision, recommendation of the City Manager or any cite board or committee: or any action, decision or recommendation of any city personnel during Ilse time period of the entire decision-making process on such action, decision or recommendation that foreseeabiy 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!/7 lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. )�66l-Z 2C C.t1 0-'%' ti�cr L. NAME OF LOBBYIST: (Last) (First) C,-4j S GLL b I D`D tA1. {.c,v , N I O o t71 BUSINESS NAME AN)ADDRESS (Number and Street) (Cliv) (State (Zip Codo) .. TELEPHONE NUMBE:2: FAX rJUMBER: MAIL: [/ Please notify thin office if your contacts Information changes:address,phone, or e-mail address. I. L066YIST RETAINED BY: NAME OF PRIN PAL;CLIENT; BUSINF-SS NAME AND ADDRESS (Number and Street) (City) (State), (7-ID Code) TEL PHONE NUMBER, FAX NUMBER:(Optlonal) EF., IL:(0 tion.9l P ) Fill out this section if nrinclpal is a Corporation,Partnership or Trust[Section 2-182(c)] • NAME OF CHIEF OFFICER.PARTNER.OR BENEFICIARY: �. Ct to a c.+0 lv Lfn..0 • IDENTIFY ALI-PERSONS HOLDING,DIRECTLY OR INDIRECTLY.A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPOR,L,TION, PARTNERSt-IP OR TRUST: Q ii.SPECIFIC LOBBY ISSUE: s t A lU i 8 ce G I r ""o �v+ll �01'1 , ri I,;r t�� V v"_.e_� Pro 0—1'], Issue to be lobbied(De„crlb9 in detail); -�.�-�1 fie. c i�� %>✓1 2 -Z( a_-o 13 In.CITY AGENC�ESANDIVIDUALS TOOK LOBBIED:. J Pursuant to City Code Section 2-482(x)(4)Include the commicsioner or.personnel Sought to be lobbied,and whether the lobbyist has,entered into any contractual lelationship (paid or unpaid) "With said city eommissionor or personnel from 12 months preceding such person's commencement of serAce with the city to tho present date,stating the eneral nature of the eub ect contractual relation, See 2-4B2(;;a)(4)Full Name of Individual and Contractual Relationship(Explain) sr hip, YES NO titlo of person to be lobbied F I G ;�riltC - ✓ Pursuant to City Code;:section 2-482(g)Every registrant shall be required to state the extent or any buGineos,financial,familial or profo mionol relatlonshlp,or other rolationship giving rise to an appearance of an Impropriety,with any current city commissioner or city personnel who Iq sought to be lobbled air identified on the lobbyist registration form riled. Sec 2-482(g)Any Fin_,mcial, Familial or Professional'Relationshipi, � a t 1 o I I'1 7 f C:1UserslclerhatllAppC:atalLocallMicrosoflWindowslTempora ry Internet FilestContent.Outl000k l83LG g�H',�ob�4r i,!U,f;Wration Formrevised 5-30-201;!.doc 11/05/2012 14: 17 2125434255 ARTDIRECTORSCLJB PtiG:E 04 F:\CLEI ii9ration Form.doc Revised 04/27/2012 M1 .4MIBEACH City of Mioir"i 940ch, 1700 Convem6on Center Drive..Miami Beach, Florida 33139,v~v.m om k o r IJl.gov CITY CLERK Office Rofoel E. Granado,City Clerk CityClerkty)mjamibfci hfl.gcv Tel; 305.6.7:?.Ul 1 , Fax, 305.673.725, LOBBYIST NAME: _se..hy�a Klz_(cr I understand that no later than February 28 of each yegr, 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) L0113BYIST EXPENDITURE AND COMPENSATION FORM Failure 'to file these forms on a timely basis will result in my name being transmitted to the Miarni-Dade County Commission on Ethics and for code violation evaluation. In addition, once an issue I have registered to lobby on has been resolved, or I am no longer lobbying on that issue or for that principal, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing, Pursuant to Section 2-485(d), the City Clerk shall notify any lobbyist (or principal) who falls to lamely file a Statement and In addition to any other penalties which may be imposecl; as provided in Section 2-485.1, a fine of$50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dada County (;ommisslon on Ethics and Public Trust of the failure of a lobbyist (or principal) to file this Statement or pay the assessed fines after notification. Any lobll3yist; who fails to file the required Statement by April 30th, 2012, shall be automatically suspended from lobbying until all fines are paid, unless the fine has been appealeil to the Miaml-Dane (County Commission on Ethics and Public Trust. Signatur Date: C:1 Users\cl erhatl\Al)p')ata\LocaRMlcrosoft\Windows\Temporary Internet Files\Content.Outlook\83LGODDH1Lebbyis1 Regl11retion Formrevised 5-30.20'2.doc 11/06/2012 14: 17 2125434255 ARTDIRECTORSCLIJE PAGnE 03 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTrrER): A) LOBBYIST DISCI...O'SURE:(Required) rv+, trt s�"rn 0 8) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION)'. (REQUIRED). AO Lt; The following information must b©answered: 1) Pursuant to Miami Beach City Code Section 2.488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": _Yes'/No: Are y4q lobbying on a present oLp ndirig b" ul ment or s_ ervjc or 4n a presenL or Pend aw rd!or aoods,equipment or sorricV 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited rnmpilgn Contributions By Lobbyists On Real Estate Development Issues': _ Yes/No: A. re)i q lobbVinq on a pending application for q Deyel4pment AgroomQn#with the City or application for chana,p of toning map desi nation or cha txe to the City's Future Land Use Map1 3) Pvrsuant Io Miami Beach City Code Section 2-482(h)Any person(except those exempt from the definition of"lobbyist"as set forth in Sec;.ion 2-481 above) who only appears as a representative of a not-for-profit corporation or entity vrithout special compensation or reimbursement for the appearance,whether direct, or indirect, to express support of or opposition to any item,shall rogister with the clerk as required by this section but,shall not be required to pay any registration fees. /Yes No: Are you repress ntin"_np_Vor_prQ`t corgoratlon or entity without special c4mpensatlon or re_irsl?Ur� _ment. V. SIGNATURE UNDER OATH: ON FEBRUARY 2f1: OF EACH YEAR EACH LOBBY S LL SUBMIT TO THE CITY C A$ICNE,D STATEMENT UN_DER OATH._L)STING L013BYING EXPENDITURES, AS WELL'AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRRCEDING_CALENDAR YEAR A STATEMENTSHALL BE FILED EVEN IF THERE_HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE_REPORTIN_G P R10D: Signature t . I do solemnly swear ghat 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 tt.e Miami Beach City Code and all reporting requirements. Signature of Lobbyist: -- Signature of PrincipaliChent: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: '1/ Produced IL) -� Y Produced ID Form of Identification { O Form of Identification t o O ,Personally 'nown(Lobbyist) = Z Personally known(Principal) D n ° 03 i; .. z VII. SIGNATURE AND STAMP OF NOTARY: > > v n D :�?. ° z 1t✓ e� }fort "' r7 �, ° N �c?Y State-of�e Fid Cain Ity of v m O y n State of-r4w4 ; County of t�4anr -$rmn__ _ ;�",Z-0 Stnvrn to and subscribed before me d � N �; � Sworn and subscribed before m: �'.-o; a b a+ This day of V z y p Thi 6 day of ✓ 0_ 2 ' ' ;: - ?,a 0. 1-i M OA__�SignatUre of Public Notary-State of Florida c s Signature of Public Notary-State of Florida o v m Notarization of�pbl,!Yibt's signature Notarization of Principal�signature R _ TO BE C MPLETEDISY CITY CLERK'S STAFF ONLY � Annual Registration ke: ( J Yes( J No Amount Paid Z MCR u 7 Date Paid Lobbyist Registration Form received and verified by. - C:\Userslclerhatf\ApFDatalLocaRMicrosoft\Windows\Temporary Internet Files\Cont,ent.Outlook GQDDH\Lobbyisl Registration Formrevised 5-30-2012.doc