Alexander P. Heckler - Parsons Brinckerhoff jca„spck4��
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139!'' i`' r , I: 20
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 1
has specific exclusions. Please/refer tto�Ordinance 2004-3435.
NAME OF LOBBYIST: (Last) (First) (M.I)
LAN POZMINe}r i A-zur Csadk9,t R 9e 1(vc 1 miami WO/ 905 Ig
BUSINESS NAME AND ADDRESS (Number an Street) (City) (State)
((Zip Code)
lo� o C9'72- 5 A4-eC L�0a�+l S.NO
T EHONE UMBER: F MBE : EMAIL:
Please:notify this-o ce:if:your contact-nfo ation c h ancges :a d d ress p ones oremail a. .ress.
!. LOBB ST RETAINE• B
`pit ,/, ,40 ,' 1-P a Ht c'tutt
NAME Or U� E N0r,tryi. r `/10 Q�JV caf- �c e ( ve, 4eJIA ! 'v yr
BUS NESS ' ME AND ADDRESS ` `L Number and Street) (C ` (State) (Zip Code)
•
TEL-PHONE 'UBER: 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: Ma r I e- El Sic LDOUJ-ef
• IDENTIFY ALL PERSONS HOLDING,,DIFiCTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: ttNN It
.......................................................................
...................................................................
II.SS CI O OV I Eye
0AA 15(4,e ,
Issue to be lobbied(Describe in detail):
................................................................................................................................
Ill.OW:AO .: 0 0l � `" 0 .,... �
....................................................................................................................................
................................................................................................................................
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 general 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
1\k% .
OA
Pursuant to City Code Sect!'n 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 Relationship
1
F:\CLER\$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
Iv. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT PATE OR OTHER):N 0 A) LOBBYIST DISCLOSURE:(Required) , 2,,,,L0-4-1{("'
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): , am,1
(REQUIRED). J t7 Q 9 3 j lit,y
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 ou lobb in :on a 'resent or:•endin* bid for •oods.e•ui+went or services or on a •resent or.endin•
® 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 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 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
*tem,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-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SH L' SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS CO :PENS TIO RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SH.A I B! FILE EVE IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD. 1
T 41
Signature o -•byist
I do solemnly swear that all of thr fore+•ing cts are and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Be.•ch Ci4'Cod and all r orting requirements.
Signature of Lobbyist:
0
Signature of Principal/Client: l�t,t•.2) . .
g p _ k_
VI. LOBBYIST IDENTIFICATION: I 4 �w PRINCIPAL IDENTIFICATION:
Produced ID , Produced ID '40
Form of Identification Form of Identification 7
o m�-lz
Personally known(Lobbyist) c Personally known(Principal) x o
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VII. SIGNATURE AND STAMP OF NOTARY: '" dM H 3
State of Florida, County of Miami-Dade 0 1 M m 12 State of Florida,County of Miami-Dade o 2 ' N
Sworn to and subscribed before me ,/ A T '03 Sworn subscrib WO me N m This k day of _:2D1� I , " e This 11 ea, of / ,201.E 30 '.
I �dN el .i� m �f Q . l 1AII1/
ga
Signatu of ublic Notary--State of F orida `ttnature of'71-Iffr-i'- '.tart'Mate of Florida
Notarization of Lobbyist's signature N•tarizati.• of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ON
Annual Registratiof fee: [ ]Yes f. N� Amount Pahl$ X510.. . MCR:# - - Date:Paid. /,!
t:abbyist:Regist Lion Form receive. :and verifed by`
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City of Miami Beach, 700 Convention Center Drive,M amt Beech,Florida 33139,ww-w.miomibeachfl.g,v
CITY CLERK Office
Rafael E.Grenade, City Clerk CityClerk@mic-imibeachfi.gov
Tel:305.673.7411 .Fox.:305.673.7254
LOBBYIST NAME: Me4. O1I(
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
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
Stab s) filed after the due date. The City Clerk shall notify the Miami-Dade
Co.. :ty Co isslon on Ethics and Public Trust of the failure of a lobbyist(or principal)
to le the Stet-mint or pay the assessed fines after notification.
A :y lobbyist, wh. fails to fil the required Statement by April 30th of each year, shall be
au .:.:matically sus ended fro:-,: lobbying until all fines are paid, unless the fine has been
ap.•: aled to the M"-:mi.Dade C....my Commission on Ethics and Public Trust.
Signature: at :
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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