Phillips South Beach, LLC (2)
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City of Miami Beach Office of the City Oerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: dtyclerlc.@d.miami-beach.fI.uS
LOBBYIST REGISTRATION FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-4B1)
Cl Check BoX if an Amendment
Harold
(M.l) DATE QUAUFIED AS LOBBYIST
Miami Beach, Florida
Rosen
NAME OF LOBBYIST: (Last) (First)
407 Lincoln Road penthouse S.E.
BUSINESS ADDRESS: (Number and Street) (City)
(State)
(Zip Code)
(305) 534- 4757
TELEPHONE NUMBER:
(305) 538-5504
FAX NUMBER:
EMAlL:
1. LOBBYIST RETAINED BY:
Phillips South Beach, LLC
NAME OF PRlNCPAl/CUENT:
1901 Collins Avenue, Miami Beach, Florida
(Zip Code)
BUSINESS ADDRESS:
(Number and Street)
(City)
(State)
:3 8 V- 6 rr.:! ilh
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
EMAlL: (Optional)
Fill out this section If principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
See attached
. UST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPEOFlC LOBBY ISSUE:
Neighboorhood Impact ~ f2J'&6 {..'J'It~
Issue to be lobbied (DeSCribe in detail):
Ill, CITY AGENOES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Relationship
planning Department
George Gomez, et ale
Planning Board
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
A) LOBBYISf DISCLOSURE:
$450.00 an hour
.
B) PRINCIPAL'S DISCLOSURE (OF LOBBYISf COMPENSATION):
$450.00 an hour
.
1) Pursuant to Ordinance No, 2003-3393 Amendina Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions By LobbYists On Procurement Issues":
Are YOU lobbyinG on a Dresent or oendinG bid for Goods. eGUiDment or services. or on a Dresent
or DendinG award for Goods. eGUiDment or service? 0 Yes ~ No
2) Pursuant to Ordinance No, 2003-3395 Amending Miami Beach City Code Chaoter 2, Article VII Division 5
thereof Entitled "Camoaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions Bv Lobbyists On Real Estate Develooment Issues":
Are YOU lobbYinG on a DendinG aDDlication for a DeveloDment AGreement with the City or
aDDlication for chanGe of zoninG maD desiGnation or chanGe to the City's Future Land Use MaD?
DYes -JiJ No
V, SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
,STATEMENT UNDER OATH, USTING 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 Code as amended, and all
reporting requirements.
Signature of lobbyist:
Signature of Principal/Client: _
VI, LOBBYIST IDENTlFlCATION:
Sytvia DIaz
7--
,.,r. .-:
~~~~OCIOber 25,
o Personally Known~(J
f
[J Produced 10
Form of Identification
VII, SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn t.Q~and subscri~d before me
This ~ daYOf~2003.
otary Public
Registration:
[ ] ACCEPTED
FOR CLERK'S USE ONLY
] REJEmD DATE:
31 g/~63
J /
DATA ENTRY DATE:
2003
If rejected, state reason:
Registration fee paid:
2nd Revision 3{18{03
LfR\HA TL \Lobbyists\registrationa03.doc
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