Raj Singh GMBHA t\AIAMI BEACH
f Miami Beach Office f the it I
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City of eac O ceo eCy 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. Pie a refer to Ordinance 2004-3435.
NAME OF LOBBYIST: (Las (Fi (M.1)
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(P-7q M �I &(A u i 4�4� H((�.K4 I'
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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TELEPHONE NUMBER: FAX NUMBER: E AIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED B :
A M�30 C�V,&Ae_y h(Ct,OAA' "
674 1 IS, V TC / O'er tj`
BU ESS ME 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: W t_�
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY ISSUE:
L ateLS
Issue to be lobbied(Describe in detail):
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 eneral nature of the subject contractual relationship.
Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to be lobbied
CeLL*lLn MB na�vv �,
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 Relationshipr
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT
RATE OR OTHER):
~ y A).LOBBYIST DISCLOSURE:(Required) 0 IPAI--O l
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): D
(Required).
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 00- Are vou lobbying on a present or pending bid for goods,equipment or services or on a
resent or pending award for goods,a ui ment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
Yes o: Are vou lobbying on apending application for a Development Agreement with the City or
a lication for change of zoning ma desi nation or change to the Ci 's Future Land Use
ao?
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.
Ye No:-Are you representing-a.not-for- rofit corporation or entily without special com ensation:or
reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1sT OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY C_LERK 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.
Signature of Lob ist
I do solemnly swear that all of the forego' g facts are true and correct an that I have read or am familiar with the
provisions contained in Section 2 2 of a Mia Beach City Code and al reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client: Cpl S VAS. �Eo 6
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID _Produced ID
Form of Identification Form of Identification
Personally know (Lobbyist) Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade State of-Florida, County of Miami-Dade
Sworn to and subscriber)b,�re a P. Swor d subscri fore me
This day of/', � � This day ,201 will
Si a re of b&96tap§:g8t ; o Signa ure lic No —° F °s
Nota izatio of Lobbyist' atur%,,� Notarizatio of Princ*
__
TIIP BY...CITY CLERK'S STAFF ONLY =2: �••a y o
Annual Registration fee: [ ] .laid•$ MCR# %p: Aift.49d 4 1
Lobbyist Registration Form r mN °:P
F:\CLFR\$ALL\aFORMS\LOBB IST r ' ' f�gistration F ors 201 .doc ��j6' °• � 2010
City®f 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
Ackniow-iledgement of fines/suspension from lobbying for failure to
comply with City of Miami Beach lobbying Laws
LOBBYIST NAME:
I understand that no later then October I st of each year, lobbyists subject to lobbyist
registration requirements shall submit to the city clerk a signed statement under oath
listing all lobbying expenditures, as well as compensation received, for the preceding
calendar year with regard to the specific issue on which the lobbyist has been engaged
to lobby. A statement shall be filed even if there have been no expenditures or
compensation during- the reporting period. The statement shall list, in detail, each
expenditure by category, including food and beverage, entertainment, research,
communication, media advertising, publications, travel, lodging and special events.
Failure to timely file the expenditure and fee disclosure report will result
in a fine of $50.00 per day. Any lobbyist who fails to file the required
expenditure report by December 1, shall automatically be suspended
from lobbying until all fines are paid, unless the fine has been appealed
to the Miami-Dade County Commission on Ethics and Public Trust. In the
event a lobbyist fails to either file the report and/or pay the assessed fines, the Clerk shall
notify the Miami Dade County Commission on Ethics and Public Trust.
In addition, once an issue I have registered to lobby on has been resolved, I am required
to imme iately notify the City Clerk's Office of lobbyist withdrawal in writing.
—/-0
Signature. Date: