M/A-Com Private Radio SystemsCity of.Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: cit yelerk~ci.miaml-beach.fl.us
LOBBYIST REGISTRATION FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
Check Box if an Amendment
Mehta. Eileen Ball
NAME OF LOBBYIST: (Last)
(First)
8/23/01
(M.I) DATE QUALIFIISD AS LOBBYIST
200 South Biscayne Boulevard. Suite 2500. Miami. Florida 33131
BUSINESS ADDRESS: (Number and Street) (City) (State)
(Zip Code)
{305) 350-2380
TELEPHONE ~BER:
I. LOBBYIST RETAINED BY:
M/A-Com Private Radio Svstems. Inc.
NAME OF PRINCIPAL/CLIENT:
3901 Derrv Street
BUS1NESS ADDRESS:
(717) 565-1206
TELEPHONE NUMBER:
(305) 351-2249
FAX NUMBER:
emehta~,bilzin-com
EMAIL:
Harrisbure. PA 17111
(Number and Street) (City) (State) (Zip Code)
(717) 565-1210
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust lSection 2-482 (c)l
? NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
Charles Shaughnessy, General Manager
? LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP
INTEREST IN SUCH CORPORATION, pARTNERSHIP OR TRUST:
A Wholly Subsidiary of M/A-Corn, Inc., A Wholly Subsidiary of Tyco International, A Publicly Traded
Company
II. SPECIFIC LOBBY ISSUE:
RFP 800 MHz Trnnked Digital $imulcast Radio SYstem, Di~,ital Multiolex. Tower. Shelter. and
~ervices for City of Miami Beach
Issue to be lobbied (Describe in detail):
IlL CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Relationship
City Commissioners
City Manager
Internal Review Committee and its Staff
Doc.#568594 v.1
IV.
DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: $350.00 p/h
B) PRINCIPAL'S DISC~: $350.00 p/h
¥. SIGNATURE UNDER OATH:
ON OCTOBER IST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH FOR THE
pRECEDING CALENDAR YEAR.
I do solemnl swear that allj~the foregoing fac..y~are tTue and co~ect and that I have read or am familiar with the provisions
·. Y~ ...... r_,a.~ ~,Siami Bead( ~ity Code as ame~cl_ed, and all r~orting requirements.
Signature of Lobbyist: ~ (.,/~' - .~_ J~ g 'J 5 ~-
VI. LOBBYIST IDENTIFICATION:
Produced ID
Form of Identification
VII.
State of Florida, County of Miami-Dade
Sworn to and subscribed I~efore me
This 'q dayof~ ,2002.
I-e~",~,' ~ MYCOMMISSIOH#OO016885 1l
X Personally Known
SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK
re of Public Noffu'y - State of Flofi
Print, stamp or type name of Notary Public
~FOR CLERKS USE ONLY
Registration: [/~
If rejected, state reason:
Registration fee paid:
DATA ENTRY DATE:
Yes [] No
Cash [~ Check MCR# _ . - ,
._~, 2002 ENTERED BY:
First Revision - 05/17/02
Doc.#568594 v.l