Carter N. McDowell - Brian L. Bilzin, Trustee 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 specific exclusions. Please refer
to Ordinance 2004-3435.
MCDOWELL. CARTER N.
NAME OF LOBBYIST: (Last) (First) (M.1)
Bilzin Sumberg Baena Price&Axelrod LLP, 1450 Brickell Avenue, Suite 2300, Miami, FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) Zip Code)
305-350-2355 305-351-2239 cmcdowell(a-bilzin.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Brian L. Bilzin,Trustee
NAME OF PRINCIPAL/CLIENT:
1450 Brickell Avenue, 23rd Floor Miami FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-374-7580
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:
All zoning, land use, and permitting matters related to Lot 6(6 Star Island Drive), Miami Beach, FL
Issue to be lobbied(Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Sec 2-482(a)(4) Full Name of Individuall and title of B)Contractual Relationship(Explain) YES NO \
person to be lobbied
City of Miami Beach, Planning Department Staff and X
Zoning Department Staff
City of Miami Beach—City Manager's Office/Jorge r X
f
Gomez J0
City Miami Beach Commissioners and Planning Board k I ID X
and Board of Adjustment '
/I UN�f�Z
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i, I f'
F TERM D AMOUNTS OF LOBBYIST COMPENSATE DISCLOSE WHETHER HOURLY
IV. DISCLOSURE O S ( ,
FLAT RATE OR OTHER)
A) LOBBYIST DISCLOSURE: (Required) $625/hr
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (Required). $625/hr
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":
❑ 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 Estate
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?
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�No: Are you representing a not-for-profit corporation or entity without special compensation or
reimbursement?
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28"' 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 FILED EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR COMPENSATION DURING THE REPORTING PERI
Si6hatur of Lobbyist
I do solemnly swear that all of the foregoin cts are true nd "orr ct and that I have read or am familiar with the provisioqT
contained in Section 2-482 of the Miami B City C d a a I rip orting requirements.
Signature of Lobbyist:
Signature of Principal/Client: r
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
❑ Produced ID ❑ Produced ID
Form of Identification Form of Identification
Personally known(Lobbyist) p, Personally known(Principal)
VII.SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn end subscribed before me ojPRY P�B�" Sworn and subscribed before me O�p0.Y P�B�/C IBIS DIAZ
This day ofO 20 2— . ••., IBIS Thi da ofP ,2011 :"'•.
* * MY COMMISSION#DD 99484 * MY COMMISSION#DD 994845
EXPIRES:May 24,2014 s P EXPIRES:May 24,2014
Signature o is Nota Stat rAA0F Fl.;q\ onde Thru Budget Notary S o hru Budget Notary Services
g ry— nature ofPublic Notary—St a o�oFR9#
Notarization of Lobbyist's signature Notarization of Principal's signature
FOR CLERK'S VSE ONLY �J Q
Annual Registration fee: Yes No Amount Paid MCR lt /O Date Paid ?i
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MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach,Florida 33139,
www.miamibeachfl.gov
LOBBYIST NAME: Carter N. McDowell
I understand that no later than February 28th of each year, I must file the following forms,
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 Form 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.
Pursuant to Section 2-485 (d), the City Clerk shall notify any lobbyist (or principal) who fails to
timely file a Statement and in addition to any other penalties which may be imposed 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-Dade County Commission on Ethics and Public Trust
of the failure of a lobbyist (or principal) to file the Statement or pay the assessed fines after
notification.
Any lobbyist, 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 appealed to the Miami-
Dade County Com ission on Ethics and Public Trust.
r
Signature: Date:
MIAMI 2966476.1 72252403 65
11/5/12
MIAMI 3392446.1 72252/40365