Michael J. Saks - Orange Bowl Committee A.
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139 ys
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the P assa dNefeat o r
modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation o-jthe City
Manager or any city board or committee; or any action, decision or recommendation of any city personnel during the t I P pe°ri`od 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.
ksaks M ichae i T
NAME OF LOBBYIST: (Last) (First) (M.I)
0 e l Co �, vi o G�. la i Laka 0
BUSINES NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
0-1 LA 172() k�o�� - L3 t -LA_K K) It IJ
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes: address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
NAME OF PR CIPAUCLIENT: 't' 1
BUS-1-NE BUS-1—NE93 NAME AND ADDRESS (Number and Street) (City (State) (Zip Cod )Lmu 0-. F . -sow I .aa
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: &i C �o S
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
n.SPECIFIC LOBBY ISSUE:
V'A I L li
Issue to be lobbied( e cribe 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
I � �
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 Anx Financial,Familial or Professional Relationship
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
� 2I
I
g
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) 1113
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): -
(REQUIRED). r 1wt
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":
_YesjNo: Are you lobbyinq on a present or pendinq 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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_YesjNo: Are you lobbvinq on a pendinq application for a Development Agreement with the City or application for
change of zoninq map designation or change to the City's Future Land Use Map?
3) Pursuant to Miami Beach City Code Section 2-482(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 BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
r
Signature of Lobbyi
'I de,s6l!5mnly.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 2-4,82 ofthe Miami Beach City Code and all reporting requirements.
Signature of-Lobbyist: Pd Ats�
ly
`Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
P
Produced ID 7)Nn e L&_o Produced ID
Form of Identification Form of Identification
Personally known(Lobbyist) Personally known(Principal)
VII. SIGNATURE AND STAMP OF N qr :"e'�•,, "USFLINE 110TEAU
���; � � •, . , - '��c-State of Mjrida State o f Florida, County of Miami-Dade ?'• M► „,.•. rXpires Apr 1f Florida, County of Miami-Dade
1� 'J'� ' and subscribed before me
Sworn tpand subscrib before e G:�� .,soon I FF 08y
This 7i day of "` ndeo Tnr day of ,2012
Olin
Signature of Public Notary–State of Florida Signature of Public Notary–State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFf ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ ® MCR# 4 Date Pifd
Lobbyist Registration Form received and verified by:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(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 lNo: Are you lobbying on.a resentor 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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes�No: Are you'lobbying.orr.a pending application for a DevelogmeM AgreemenC.v�rith the:City or application for
chancie of zoning map designation-or chancie.to the City's'Future Land Use Map?
3) Pursuant to Miami Beach City Code Section 2-482(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, ASVELL AS COMPENSATION RECEIVED.,IN THE CIT.Y.'OF'.MIAMLBEACH FOR°
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL iBE FILED EVEN IF THERE HAVE BEEN:NO'EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
r
Signature of Lobbyi
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 2-132 7f the.Mianii Beach City Code-and all reporting requirements.
Signature of Lobbyist`
Signature of Pi-incipal/C,lie_nt:
VI. LOBBYIST IDENTIFICATION- PRINCIPAL IDENTIFICATION:
ILProduced ID k—/Produced ID
Form of Identification Form of Identification
_Personally known(Lobbyist) Personally known(Principal)
VII. SIGNATURE AND STAMP OF N AR'Y�"�`',��; "'t1SELINE POTEAU
;Ic-State of Florida
"�• '� = Count of Miami-Dade
State of Florida,County of Miami-Dade J 'e 'V1► : +1° capir�a Apr f 1, 1� of Florida, y
Sworn t and subscrib• before e i;'�� ' ..stun OFF 007 o and subscri d befog Me' ,
This' '� day of S,P „ ' nuea Iniou alials may of � ,��2.: 6 2)
Signature of Public'Notary.–State of Florida Signature of Pu is Notary-Stare of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED.-BY CITY CLERK'S STAFF ONLY
Annual Registration fee: I ]Yes( ]No Amount Paid a" MCR# Date Paid
Lobbyist Rogistration Form received and verified by:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
listration Form.doc Revised 04/27/2012
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfi.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk@miamibeachfl.gov
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME: I i lc Qd T �S �S
I understand that no later than February 28 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, 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 timely file a Statement and in addition to any other penalties which may be
imposed as provided In Section 2-455.1, 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 falls to file the required Statement by April 30th, 20129 shall be
automatically 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
Signature: Date:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Forrnrevised 5-30-2012.doc