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Brandon N. Berry - Live Nation s � ' M].-BEACH 1 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 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 in lobbying activities. The term"Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. NAME OF LOBBYIST: (Last) (First) (M.1) BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) rL2(3050 q 3b­2_5LIO k�05) A TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: �J� 1�14T1p� NAME OF PR-II�CIPAL/CLIENT: �f III �'i%0VJ i l oo (J AI rJC`TVw � / 111 . `t3 1 F 3313 BUSINESS NAME AND ADDRESS (Number and SStt�get) (City) (State) j (Zip Code) Cis) ( ti/p-1 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: Su'�1-� �fci��1 ��w� y FE%IVV4._ {fitVC�4 C�(L�itir Issue to be lobbied(Describe in detail): III.CITY AGENCIESIINDIVIDUALS 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 ' MINI c S UIIZ " GrjjiFAj-Tw-j F Pursuant to City Code Section 2-482(8)Every registrant shall be required to state the extent of any business,financial,familial orwfessional relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner or co,pers nel,o is sought to be lobbied as identified on the lobbyist registration form filed. Sec 2-482(g)Any Financial, Familial or Professional Relationship Q M r. . ti �� N v , C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Regist ati n Formrevised 5-30-2012.doc ` (DISCLOSE DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION ( E WH ETFIER HOURLY.FLA T Rai TE OR O T A) LOBBYIST DISCLOSURE:(Required) B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (RSQUIRED). The following information must be answered: 9) Pursuantto Miami Beach City Code Section 2488 Entitled°Prohibited Campaign Contributions By Lobbyists On Procurement Issues": Yes�No: &IM lobhAgg a VLqjent or ndin for g s ui ent o rvIce9j2ron a gM§entsr pending award for ods Iii m or rvice 2) Pursuant to Miami Beads City Code Section 2190 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": Yes No: Are vI_I®bbvino on a ueiding.MR211 ti2a fQr a Dey®lonment ®reement with the City or appllcatton for Change of zorein ma desi n tion or Chan a to the Ci 's Futu[§Land U M MaD? 3) Pursuant to Miami Beach City Code Sermon 24182(Ih)Any person(except those exempt from the definition of"lobbyist"as set forth in Section 2-489 above)who only appears as a representative of a not-for-profit corporagon 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.IVo: Are you rel3resentina a riot-fbr-pro8t gQrRg atfori 9f entity WithoUtIMCIMI compensation or relntbursement V. SIGNATURE UNDER OATH: N FO.EWARY 28 OF 9AGH MA_& LOB T SHALL SUBMIT xQ THE CITY CLERIC A SIGNED STATEMENT UNDr O TH TlNG L OB BY1bj2 EXPE DITU AS WELL A&COMPENSA ON CEI THF,CITY OF MIA I BfAC FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE H BEEN NO COMPENSATIO�URING THE REPORTING PERIOD E NDiTURES OR Si f La gist I do solemnly swear that all of the fo going facts are true and correct and that I have r ad or am familiar with the provisions co in Section 2-482 of the Miami a C' de a 11 reporting requiremen in d Signature of Lobbyist: - a Signature of Principal Clio �c; ,. Vi" LOBBYIST IDENTIFICA ION: a PRINCIPAL IDENTIFICATION: C o c � C) roduced ID FL�) w ,2 t �I `b'`ti "``' � ° `O m ro Pduced ID Form of Identification c ti QQ _ ° y y y m Form of Identification a Personally known(Lobbyist) ' �Q 4-z z. ersonally known(Principal) Vii. SIGNATURE AND STAMP OF NO RY;�c E F � Q C State of Florida,County of Miami-Dade 4P o State of Florida County of Miami-Dade Sworn;t nd scribe afore me ,•�`' :''�� Q' This d of =°`�c d Sworn and subscribed bepore me `QJ b+• O: `r 2Df2 0- his _dey of b Y -x � 2012 Signature f Public Not ry tate of FI Signature of Public Note Notari h of b st' signature ry— ate of Florida zat' Notarization of incl al's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual-Registration fee. S1 ]No AMount Paid • M l .# [1o!D6yIgtftdaiitrafion Form received and verifled by: to Paid / C:\UserslclerhallAppDatelLocaftMicrosoMWind Internet FileslConte Forrnrevised 5-30-2092.doc ' AMANDA BREIGH MEDIEIROS S .', MY COMMISSION it EE212159 EXPIRES June 27 2018 aU+ 3yb-u�s� i F:\CLEI iistration Form.doc Revised 04/27/2012 3 P. kIpC 6 x IV f. ' zT City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov Tel: 305.673.741 1 ,Fax:305.673.7254 LOBBYIST NAME: 't3VA,1J170"J 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 2-485.1, 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 Commission on Ethics and Public Trust. /3 gnature: Date: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc 4:1 - IL CL ca VE r . . • - c o2 � ' � f: a f:t o �. : LL mom LL CL .r. l ❑ a Q : CL