Supplemental Information 3/10/3City of Miami Beach Office of the City Clerk ~ ~ C ~
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBY 'ST S U p P LEI I E O N
l)
Pursuant to Ordinance No. 2003-3393 Amending Miami Beach City Code Chapter 2,
Article VII, Division 5 Thereof Entitled "Campaign Finance Reform" Via The Addition Of
Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On
Procurement Issues":
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?
D Yes Ill/No
2)
Pursuant to Ordinance No. 2003-3395 Amending Miami Beach City Code Chapter 2,
Article VII Division 5 thereof Entitled "Campaign Finance Reform", Via The Addition O~
Code Section 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
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? DYes ~1o
V. SIGNATURE UNDER OATH:
ON OCTOBER IsT OF EACH YEAR, EACH LOBBYZST SHALL SUBMZT TO THE CZTY CLERK A SIGNED
STATEMENT UNDER OATH, LIbl J~NG LOBBYZNG EXPENDZTURES IN THE CZTY OF MIAMI BEACH FOR
THE PRECEDTNG CALENDAR YEAR.
! do solemnly swear that all of the foregoing facts are true and correct and that ! have read or am
City Code as amended, and all
familiar with the provisions contained i_n ~;ection 2-482 g~he Miami Beach
reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VL LOBBYZST XDENTZFZCATZON:
u Produced ID
Form of Identification
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This. J0~ day of ~/~/,~ ,
2003.
P/ersonally Known
SZGNATURE AND STAblP OF NOTARY OR DEPUTY CLERK:
Signature of Public Notar~ State of Florida
15tint, stamp or type name of Nota~ Public