Samuel A. Rubert - Indochine Miami, LLC (2) PP n '
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City of Miami Beech Office of the City Clark � 0�
1700 Convention Center Drive, Miami Beach, FIB 33139
LOBBYIST REG!;s(RATION FORM
Lobb.01:means all pen is empbyed or retained,vAother paid of r scat, by a pfincipal who seats to encowap ft pa or
modif eaflo I of soy er nanc , resolutim, aetion or'dedsion of Rnv C Mtfliffis#oftr;any action,decision, recxa nme icy of the Ck
mane or airy city board or commitlee;or any Action,decision of,or,ommendallon of any city personnel durft th+e time period ttf,the
entire dedision-making Process On such actin, decision (x recom E aert tit.Wesseabtyr will to heard or reviewed by the dly.
commission.of a+qty board or committee. The 1drm specifically includes the pfloc al as wolf as any employee engaged in lobWag
victivities. The terin"t ebbytrAss"has specific exclusions. Pleas(, refer to Ord araaar 2004.3435.
W-1)
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F1MNESIS NAIA AM ADOWSS (#Ufter and Street) (c,'ty; PIRW (Zip )
,wlq
TEL PHJii?! _ M R: FAX NUMBER: 4 EMAIL:
ff YOOr 00n0cf Infortna 0 n changes:,address phone,or+s•rnatf address.
I. LO"Yl$TfMTA1f400GY;
4L IALSdftis
NAME OF PRI JCLIENT.,
F LAAi s `(4 ; geath rl- orsdi.-M.
t SUMESS Et 'r (l imner ancf Streotj J (C ty) (Stele) (Zip Ccide}
Tit FAX NUM ER,{Opt"l) EliilA'it:(Optional)
Fill og on 0 prbaIpai is s carporattoin,I artnorship or Trust(Section 2•442(c)t
* NAME OF CHIEF OFFICER.PARTNER,OR DEWFIC1ARY:
• Ii NT)FY ALL PERSONS Mf1f..p)i G.DIRECTLY OR INDIRECTLY.A b%OR MORF OWNERSHIP INTEREST IN SUCH CORPORATIoNi
tAttTtlF�Oft"'eft l#faT
ism*to be ,. softe ill
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tit.CITY AGENCIESUDINIQUALS TO BE LOBBIED:
Pursuerit,to-CW Dar t)t►n"2(a){41 lncludo the commissioner or porsennal ao%# t6 be lobbied,and,cth*Owr the tobbVW hn entered
11ft any #a il► (paid )WO said city c�ommisakwWr cat prr€t01" ftoa:� 1� +rraduths prece�fi '�t►'s
. „ t+mvth+a �thl dot tatin # F i�eral a�ltura taf the a ship. _
Of Individual and Contractual Relationship(Explain) YES N4
a► � exsort
to to Lobbied
r
Pursunn#llo l etu tiara°2 �y rag�istrsnt she!!tae �1'000W,tb state tho extent cal any buskw*s,Tina nclal,families or pr+ saiec►a!
with any current city commissioner or city prerse anal who is
Si+a+G 24142ja}KnY.t ltta►n taail e'MRIsi Or PtoMssronal F*14-ion Nil
C✓:%Userstderl {;Appt)ata%LocartM Oftlli-lOWTernporary lnh rn:>f FileslCoiitent.Oull a .t HWW obb*t Rewstration
Formre ised 5-30-2012.dm
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7
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IV- DISCLOSURE OF TERMS AND Ado"TS CW LOBBYIST CONIP'1~M A 71011#tDISCLOSe Wt1 TMER HOURLY,#IAT RAPE Olt tlM:
A) LOBBYIST DISCLOSURE:(0"Uhed) t I i{,
j ^w.
01 PRINCIPAL`s MCLC RE(OF LOBBYIST COMPENRA710N):
tl�EIIR
The following Infom ation must be answered;
I Pubs to Miami nth Cftit Code Section 2-488 Entitled Prohibited Campaign Contributions By Lobbyists On Procummnt
Ism"-
.-A Yes, io: r ipg, it
nds uI nt ` '
2) Pursuant t0,K0MJ Rwh City Code Sedion 2.490 Entitled Pfohlbited Campaign Gontributibas By Lobbyists On Real Estate
DevekVmenj ltea":
—Yes 4 0-. malicaminkr or
3) PUMUSM tO 11W 8000h City Code Section 2482(h)Arry person(exceo those exemo from the deflin i am of'MAW as yet
fir 2 11 ove)'who-only appears as a retai n#Nltive of a n 1x' . fit c� r or a"VAOWW special
aY ur t four#far appearance,whether tftct, OF I , to a sup, of of Opposition to
shsll *� �as required by tut,al I not be c ta pay any font ,
Yell� .
Haag a GO mom=920016 r en h
V. awwatm tweR T"
TO._
AS WMPffftal or
c"natdfo of Lohbyig
I do sokaw y swear that oil of the jomgokV fMAe are true and oorred' and that I have read or am familiar with the proviskm s vontained
in Section 2-+ 2 ai the Miami JW an reporting requirements.
Signature of tobbt: .
Signature of P W lent: `
VL LOBBYIST WENTIFICATION: PRINCIPAL.IDENTIFICATION-.
Produced 10 Produoad 10
FaM of Idenfifte Form of ldenftallon
know tt"ethla '
�� � r F'emortally known(tr:ttpa#)
VII. SORATUR9.A 7►STAMP OF MW State of Flom, 'at WWI-Dade
State of Florida.Cam
Sw r
t>u re me " �Orn and su '
y�� � � .� �: This ��' AFtIS�E
EC.. ..
r ►t r8 ., -,State of
J.F RR4TROADE
: P�bIIG _ of Fta a NOTAIRES
�►A Z N atlon of `P sign turf83994 SAINTTROPEZ
To BE COMPLETED BY IS ttE SL
AL Am t ,Y
1!101 W Om sndverftd�E
Pfd1GIt
C.*Wftm ft#VopDab%LocWWk:tosofhWIAdow%%Temperary Inteme,I Files%Content.OuDooW3LOQWN%Lobibylst Registration
I=ormovised 6-30-20112.doc
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Chy of MkMI Uarb, 1700 Cann,n"i Cmaw wive,Miotoi Rf,,<h.flotidn 331.39',www.miemi6oc49_Vov
CITY CkERK mice
�t cwl E.Gropado,City Clerk C,ityC1erk#mtamfb chI1.goc
T l� 305,673,7411 .Fax:305.+673.7254
1-CMY[ST NAMI: . 004.�__ 4
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1 understand VW no later than F . "Q4_4 i U$t file the follOW11 form
t of the i ia h y apu a de,,. ,
With the City Clark's ice for
aN ave4obbylg issues,
1.) LOOSYMTEXPENDITURE AND COMPENSATION FORM
Femur o to Ale these forms on a timely basis will result to my name bring transmitted to
this Miami-Onde County Commission on Ethics and for code,viol' evaluation.
In a
once an Issue i have registers to lobby an has been resolved,, or l am no
l . r JObbykV on that Woe or for that principal.. I art required to komedlately ratify
to
01ficleWsOfflee flf obbylst Withdrawal In writing.
.tin'teuent to Semen S( )o the City Clrvrk shalt notIfy lobbyist(or prim who
WO 10 t1 1y a Statement mul In addition to any oOw ponalties, which may bo
In Sin 2 .1, a fine of
$50M&day,shaD be amassed*w iW1
�s aftw the due date. The City s the Mia
:. on.Mica and'Public Trust of !r JWWre of a,. Abby. t or la ndp )
to X11 qtr pay'the assessed tines air no
A" 10bb*t� Who the fired Statement by Ate# 2012, sMN be
UOPOPIP ftm.lobbyinq until all figs are paid.,uniess"fine hasIbeen
to the.lMpe County Commission on Mica and PublIc Trust.
aulwig,*,D*U,-OowjomsofowkxiowskTomporary ttttermot Foosicorit °tt.Qutb¢ . tt R tr t
Fomiravi d 5- T2.doc