Ronald Fieldstone/PenrodCiD/of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: cityderk@d.miami-beach.fl.us
LOBBYIST REGI'STRATI'ON FORH
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
r~ Check Box if an Amendment
RECEIVED
03 JUt. 29 PM 2:22
~" CLERK'S OFF ~CE
NAME OF LOBBYIST: (Last) (First) (M.I) DATE QUALIFIED AS LOBBYIST
BUSINESS ADDRESS: (Number and Street) (Cit~) (State) (~ip Code)
d~:E)~, 5,~c). ~C'~c~I ~0.~ .':~r'). lC.W_)'?_
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
BUSINESS ADDRESS: (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2~,82 (c)]
· NA[q_E O_,F CHIEF OFFICER, PARTNER, OR BENEFICIARY'.
· LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
SPECIFIC LOBBY LSSUE:
-- I~ue to be lobbied (DesCribe in detail):
IlL CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Tilde B) Relationship
FLATRAT~ OR OTHER):
t)
2)
Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach Citv Code ChaDter 2. Article V[T, Division 5
Thereof Entitled "Campaiqn Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Campaion Contributions By Lobbyists On Procurement Issues":
Are you Iobbvina on a Dresent or ~endino bid for qoods, eoul~t or services, or on a Dresent
or pendinq award for qoods, enuiDment or service? Yes ~
Pursuant to Ordinance NO. 2003-3395 Amendine Miami Beach CRv Code Chapter 2, Article VII Division 5
thereof Entitled "Camoaien Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Campaiqn Contributions By Lobbyists On Real Estate Develooment Issues":
Are you Iobbvina on a oendina aDDlicaUon for a Development Aareement with the Ci~( or
aDDlicat~ chanqe of zoninq map desiqnaUon or chanqe to the CitY's Future Land Use MaD?
V, SZGNATURE UNDER OATH:
ON OCTOBER Is~ OF EACH YEAR, EACH LOBBY[ST SHALL SUBMTr TO THE CTTY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOB~Y/NG EXPENDI'rURES IN THE CITY OF MIAMI BEACH FOR
THE PRECEDTNG CALENDAR YEAR. //
//
! do solemnly swear that all of the forCg/6ing ~ts are true and correct and that T have read or am
familiar with the provisions contained/~( Secl;jorJ 2-482 of the Miami Beach City Code as amended, and all
Signature of Lobbyist: I ,Y
Signature of Pdndpal/Client:
LOBBY/ST ZDENT/FTCAT/ON:
Produced iD
Form of identification
~'~rsonally K now~-~'~
VI/. S*rGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Hiami-Dade
Sworn to and subscribed before me
This ~--/~* day of g 0(-1 ,2003.
..~,~. 0E
.L~L~~ -~'"' ' "-'-' ~-" '"¢*;~'
Signature of Public No~ - S~te of Flodda
Print, s~mp or ~ name of No~ Public
Registration: ~"-ACCE PTE D
If rejected, state reason: _
Registration fee p aid:--~'es [ ] No
DATA ENTRY DATE: /'//"~O
2nd Revision 3/~.8/03
FOR CLERK'S USE ONLY
[ ] Cash ~-Check MCR.
,2003 ENTERED
F:~R\HATL\Lobbyists\registrationa 03.doc
FLA T RA TE OR OTHER):
Pursuant to Ordinance No. 2003-3393 Amendinq Miami Beach City Code Chapter 2, Article VI[, Division 5
Thereof Entitled "Campaiqn Finance Reform" Via The Addition Of Code Section 2-4-88 Entitled "Prohibited
Camoaion Contributions By Lobbyists On Procurement ~ssues":
2)
Are you Iobbvina on a present or oendinq bid for qoods, eq~.t or services, or on a present
or oendina award for aoods, e~uioment or service? Yes (~/
Pursuant to Ordinance No. 2003-339S Amendinq Miami Beach City Code Chapter 2, Article V~! Division 5
thereof Entitled "Campaiqn Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaion Contributions Bv Lobbyists On Real Estate Development !ssues":
Are you Iobbvina on a I~endina aoolicaUon for a Develooment Aqreement with the City or
applica~o~ chanqe of zoninq map desiqnation or chanqe to the City's Future Land Use Map?
V. SI[GNATURE UNDER OATH:
ON OCTOBER Ist OF EACH YEAI~ EACH LOBBY[ST SHALL SUBM1T TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH~ LISTING LOBBY[NG EXPENDITURES ~N THE CITY OF M!AM! BEACH FOR
THE PRECED!NG CALENDAR YEAR.
1[ do solemnly swear that all of the foregoing facts are true and correct and that ! have read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach Cib/Code as amended, and all
reporting requirements.
Signature of Lobbyist: ~'~ ~"~~~ ~-r/~
Signature of Principal/Client: ~~~
~ Produc~ ID
Form of I~ntifi~tion
nally~.~//
SZGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
This 2.q day of ,Jo~f
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
,2003.
Sig natu~,~,
Prin~,~
f P~l~ic Notary - State of Florida
Sloven 3. S~arace
or~~~ Public
Registration: ~I~AccEPTE D
If rejected, state reason:
Registration fee paid:~-Yes [ ] No
DATA ENTRY DATE:
2nd Revision 3/~-8/03
FOR CLERK'S USE ONLY
,2003 ENTERED BY:
F :\CLER\HATL\Lobbyists~-gistrationa 03.doc