Santiago D. Echemendia/T. OgdenCity of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: dtyderk@d.miami-beach.fl.us
LOBBY]~'I' REGlr~'I'RATTON FORM
(City of Miami Beach, Ob/Code Chapter 2, Division 3, Section 2-481)
Q Check Box if an Amendment
NAME OF LOBBYIST: (Last) (First) (J
BUSINESS ADDRESS:
(M.I) DATE QUALtFtED AS LOBBYIST
(Number and Street) (City)
(State) (Zip Code)
TELEPHONE NUMBER:
FAX NUMBER:
EMAIL:
LOBBYIST RETAINED BY:
NAME OF PRINCIPAWCLIEF~r:
BUSINESS ADDRESS: (Number and Street) (City)
TELEPHONE NUMBER: FAX NUMBER: (Optional)
(State) ~ (Zip Code)
EMA~L: (Optional)
Fill out this section if prindpal is a Corporation, Partnership or Trust [Section 2-482 (c)]
· NAME OF CHIEF OFFICER, P/~TNER, OR BENEFICIARY:
· ITST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Iss to.lob 'ed(O~dbe' de il): - O
~. ~If A~EN~E~/]NO~DUA~ TO BE LOBBIED:
A) Full Name of Individual/TiUe B) Relationship
FLA T RATE OR OTHER)=
A) LOBBYISTDI$CLOSURE: ~'"'~ ~-? ~
B) PR[NC[PAL'S D~SCLOSURE (OF LOBBYIST COMPENSATION):
2)
Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2, Article VII. Division 5
Th(~reof Entitled "CamDaion Finance Re~o~ hi" Via The Addition Of Code Section 2-488 Entitled "Prohibited
C, amDaion Contributions Bv Lobbyists On Procurement Issues":
Are you Iobbvino on a oresent or oendino bid for ooods, eouioment or services, or on a present
or oendino award for Qoods, eouiornent or service? Yes No
Pursuant to Ordinance No. 2003-3395 Amendino Miami Beach City Code Chapter 2. Article VI! Division 5
thereof Entitled "CamDaion Finance Reform", Via The Addition Of Code Section 2-490 EntiUed "Prohibited
Camoaion Contributions By Lobbyists On Real Estate Develooment Tssues":
Are o I b in n ndin a Ii ion foraD v I e A r emen wih i r
a h ~ nf rchan eofzomn ma e ~ naUonorch n e heCl ' Future Land s M ?
Yes No
V. SIGNATURE UNDER OATH:
ON OCTOBER IsT OF EACH YEAR, EACH LOBBYIST SHALL SUBMI'r TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LTST/NG LOBBYING EXPENDTTURES IN THE CTTY OF M/AMI BEACH FOR
THE PRECEDING CALENDAR YEAR.
I 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 City Code as amended, and all
reporting requirements. ~
Signature of Lobbyist:
Signature of Principal/Client:
LOBBYZSl' IDENT~F~CAI'ZON:
Produced lID
Form of Identification
V~/, SZGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of FliamFDade
Sworn~to~,~d subscribed .before me
This.~ day of ~ 2003,
Personally Known
~ offPublic,l~'otary - State of Florida
15rint, ~amp or ~/~-n~'me of Notan/Public
FOR CLERK'S USE ONLY
Registration: [ ] ACCEPTED [ ] RE1ECTED DATE:
If rejected, state reason:
Registration fee paid: [ ] Yes [ ] No [ ] Cash [ ] Check MCR #
DATA ENTRY DATE: ,2003 ENTERED BY:
2nd Revision 3/18/03 F:\CLER\HATL\Lobbyists\regisb'ationa03.doc
DZSCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DZSCLOSE WHETHER HOURI
.,FLAT RATE OR OTHER,):,
A) LOBBYIST O;SCLOSURE: ~ '~ ~ ~ x~"~.'.~ //-..~/ o- ~ ~
B) PRJNC~PAL'SD~SCLDSURE(OFLOBBYZSTCO.PENSAT1ON):''~ ~'-~ '~..._ '~ f.Z~"~'' /Z~..~ ~ ~
1)
2)
Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2. Article V~I. Division 5
Thereof Entitled 'Camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled 'Prohibited
Camoaian Contributions Bv Lobbyists On Procurement Is~¥es":
Are you Iobb¥ina on a aresent or oendina bid for aoods, eauiament or services, or on a oresent
or oendina award for aoods, eaui=ment or service? [] Yes ~
Pursuant to Ordinance No. 2003-3395 Amendinq Miami ~ach City CcxJe Chapter 2, Article VII Division 5
thereof Entitled 'Camoaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled ~Prohibited
Camoaian Contributions By Lobbyists On Real Estate Develooment Issues":
Are you Iobbvina on a Dendina aDDlication for a DeveloDment Aareement with the City or
aDDiication for chanae of zonina mad desianation or chanae to the City's Future Land Use MaD?
DYes ~
V. SIGNATURE UNDER OATH:
ON OCTOBER ].s'r OF EACH YEAR, EACH LOBBYZST SHALL SUBHTr TO THE cTrY CLERK A SZGNED
5TATEHENT UNDER OATH, I.tbizNG LOBBYING EXPENDTrURES IN THE CTrY OF f.t~AHZ BEACH FOR
THE PRECEDZNG CALENDAR YEAR.
! 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 City Code as amended, and all
reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client: ~ d -- ~
LOBBYIST ZDENT~F~CAT~ON:
a~Produced ID~~1-- C~,~-"~--I '~O-2-°~-O [] Personally Known
Form of Zdentification
VZZ. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to and subscribed I~efore me
This ~D'~['~ day of,_~ ,2003.
-
I OFFICIAL NOTARY SEAL '/
LILLIAN BEAUCHAMP
NOTARY PUI~LIC STATE OF FLORIDA
COMMISSION NO. DD~09289
MY COMMISSION EXP. APR. 29,2006
Print, stamp or type name of Notary Public
Registration:
If rejected, state reason:
Registration fee paid: ~ '] No
DATA ENTRY DATE: /~//./1~
2nd Revision 3/18/03
FOR CLERK'S USE ONLY
/ .,,.-/
[ ] RE.1EcIt:D DATE: __,~/~.~=~/~'~'~
F: \CdR\HATL\Lobbyists\registrationa03.doc