M/A Com Private Radio Systems
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: cityc1erk@cLmiaml-beach.f1.us
LOBBYIST REGISTRATION FORM
Powell. Norman C.
NAME OF LOBBYIST: (Last)
(First)
8/23/01 .~ ~
(M.!) DATE QUALIFIED AS LOBBYIST
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(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
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200 South Biscavne Boulevard. Suite 2500. Miami. Florida 33131
BUSINESS ADDRESS: (Number and Street) (City) (State)
(Zip Code)
(305) 375-6144
TELEPHONE NUMBER:
(305) 351-2249
FAX NUMBER:
npowell@bilzin.com
EMAIL:
I. LOBBYIST RETAINED BY:
MIA-Com Private Radio Svstems. Inc.
NAME OF PRINCIPAUCLIENT:
3901 DeITY Street
BUSINESS ADDRESS:
Harrisbure.
(Number and Street)
(City)
PA
(State)
17111
(Zip Code)
(717) 565-1206
TELEPHONE NUMBER:
(717) 565-1210
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:
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-Com, Inc., A Wholly Subsidiary of Tyco International, A Publicly Traded
Company
II. SPECIFIC LOBBY ISSUE:
RFP 800 MHz Trunked Dhtital Simulcast Radio Svstem. Dieital Multiplex. Tower. Shelter. and
Services for Citv of Miami Beach
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual!fitle B) Relationship
City Commissioners
City Manager
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Internal Review Committee and its Staff
Doc.#568594 v.8
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: $300.00 oth
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): $300.00 oth
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST 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 solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions
contained in Section 2-482 of the Miami Beach City Cod ame ed, and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
=> Produced ID
Form of Identification
X Personally Known
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK
State of Florida, County of Miami-Dade
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This L ay of , 2002.
FOR CLERKS USE ONL
REJECTED
Registration:
[~CEPTED
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Ifrejected, state reason:
Registration fee paid:
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[ Check
,2002
I First Revision - 05/17/02
Doc.#568594 v.8