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P. Kirk Paskal - Winter Music Conference Inc. • UCACPWII-TC14(� w S MIAMIBEA H City of Miami Beach Office of the City Clerk �f k, . 1700 Convention Center Drive, Miami Beach, FL 33139 ��. ,r 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. Please refer to Ordinance 2004-3435. Pa3Ko ( F. KirL NAME OF LOBBYIST: (Last) (First) (M.I) l�UinTPA mu5 X-C. CoPere'ic /rc . 3'150 #J !a Terrace , Fitaoc/ 3333 y BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 95(/ 4,3 . L/L/L4Lf 9541- 563- 159j I.(-It Win i-ertnusrc.con rereAce.cool TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: (A)l n+U. rn u5 I C Con-P re nc e. Inc NAME OF PRINCIPAL/CLIENT: 3450 JUG ` Terrace. F-4 Laud. F'c 5333 y BUSINESS NAME AND ADDRESS (Number and Street)_ (City) (State) Zip Code) 95'I- 5403- Y�YY '15'/-56 63- 159 9 Kirk. 6 fecmccsiccon-E'eir°n.ce. 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: Lou!3 PD55Ccrll • IDENTIFY ALL PERSONS HO DINQ,DI CTLY O INDIREC ,,f‘5%O M 1RE 9WNERSHIP INTEREST,IN SUCH CORPORATION, PARTNERSHIP OR TRUST: 15 roo55 1 lam I(CJl y J( • 507o each ii.SPECIFIC LOBBY ISSUE: 7 VC Gcox) - T'Uur I's tn and Advancer al Pro rcur) Issue to be lobbied(Describe in detail): L Ill.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 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 board ✓ v cA � 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 Relationship No rel cc-Ho/1511,p 44,1 VC13 8oar01 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc , IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) Cc, a, ed em `o ee B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): Sala( �I f (REQUIRED). S I L 1 ye e 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": —YesZlo: Are you lobbying on a present or 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 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 /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 Y OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAV EEN EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobb 'st I do solemnly swear that all of the foregoing facts are true and corre' and t .t I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting req rements Signature of Lobbyist: _Fctx......._„...., r Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID r-1"4,4 Afooto Li 4r' . a. $ ✓Produced ID 1''4(4t t 11<+5 11 Q,l'4 N I Form of Identification 7_A F3 Form of Identification u_°.co ad m Personally known(Lobbyist) z •u- Personally known(Principal) g U 2 VII. SIGNATURE AND STAMP OF NOTARY: °6 re a- "' a' �� re E E Ya E E s�E E State of Florida,County of Miami-Dade o State of Florida,County of Miami-Dade o" I$ Sworn to and subscribed beforq me 2"A' Sworn anQ,.subscrib befo a me Z This 5 day of t.I00•41 Y,201 S� This 2., day of 4�1 ,201 Q°e�c- wh �lr ` 1v�n �v�t�t4/1 ��•t[ Sign ture of Public Notary–State of Florida – '�i -- g ry S a o o da Signature of blic Notary State of Florida to Notarization of Lobbyist's signature , p Notarization of Principal's signature " TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ j Yes[ ]No Amount Paid$ $! CR# 1-1/15):1)3(-) Date Paid l 113D/�,� Lobbyist Registration Fo eceived and verified by: .k ywM� F:\CLER\$ALL\aFORMS\LO BYIST FORMS\Lobbyist Annual Registratio Form. oc Revised 01/22/2014 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc MIAMIBEACH 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:305.673.7411 ,Fax:305.673.7254 LOBBYIST NAME: P. Ic t r K. Pa5VcJ 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 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 -tement by April 30th of each year, shall be automatically suspended from lobbyin• ntil a fines are paid, unless the fine has been appealed to the Miami-Dade County C•mmissio on Ethics and Public Trust. 11/2S/15 Signature: Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc . - _ , I_L5'K t1+ w n+r ,s4 A6j }. 9�L - _ Miscellaneous Cash Receipt - t '.+ . _ - �; ' CITY OF MIAMI BEACH • 0 Cash. 0 Credit Card Check# I O = $ " A.,) 3,e) 20 Received of 1 tt 5 IA of • Address ':.2'-‘ .) )1v r.: i .1- ter _ i r. For '.,>�„ in h1 r 4 �L.{ .i 5 Y� 6"a ^‘'"°'}} (f ;.,^f; , \1 :+Viltl.1,f 1" t i) I C:-,1 1) r) r Lt,e- �-,r,.' r V ' (THIS INFORMATION MUST BE COMPLETED) - Office of Finance Director ems' ,;, By' , ° C(H ` 6Y or)- e7 , . . `:Account Number..: � • 1 cam:- Prepares: '�c -I Co g.-f 1 4 Dept. .-Cr 'r 1( t°Gil.... - EXT.' ;1 (f f trl . City of hliami Beach-Florida Finance Department 1 City Hall 133420-1 11/30/2015 BRTrans#35-35 hlon Nov0,2015 11 .26AM 35 � 80.00 MCRCLERK - MCR-City Clerk * MCR#; 408336 1 ITEMS): TTAL: X85850000 Check (010814O) PAID $ Have a nice day!