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BSG Development Corp. City of Miami Beach Office of the City Clerk 1700 ConvenUon Center Drive, Miami Beach, FL 33139 LOBBYIST REGZSTRATZON FORM (Oty of Miami Beach, City Code Chapter 2, Division 3, Set,on 2-481) R/Check Box if ,n,A mendment ~ ~ LOBS~ST: ~ {L~st) ' ' (n.rst) ~'~ QUAU~i.-O)S Loem'ZST BUSZNES$ ADDRESS: (Numi(M and Street) /(t~ty) ' (State] I [Zip Code} ~a~E NUMBER: F~Q( NUMBER: EMAII.: NAME OR i~AUCUENT: BUSINESS ~'O[~SS: (~umber ~ Strict) (Oty) (Siai~) (Z~o C~) 305 - TELEPHONE NUMBER: FAX NUMI~R: (Optional) EMA~L: out I~M M~on i~ prMclpal k · ~ Palm.hip or Tn~t [Section 2-4~2 (c)] LZST ALL PEPYS NKN. DING, DIRELY OR INOIRECTLY, A $% OR MORE OVVNEP.~ I~ IN SUCH A) Full N~m M' Zn(livtdual/TIUe / I) RelatlmmhJp FLATRATEOR OTHER~. ~~ A) LOBBY[ST DLSCLOSURE: 6 ~a ~' B) PRZNCZPAL'S DLSCLOSURE (OF LO6BY[STCOMPENSAT~ON):~P~/'~ pursuant to Ordinance No. __~__~-3393 Amendlna Miami __ne?h CRv Code Ohaoter 2. ArUde VI2. Division 5 Thereof EntiUed '~amnai~ finance Reform~ Via The AddlUon Of Code Section 2-488 Entitled ~Prohibited Camoai~n Contributions By Lobbyists On Procurement [ssues": 2) Pursuant to Ordinance No. 200:3-_~_~__~ Amendlna Miami Beach Cltv Code Chaoter 2. ArUcie VII Division S thereof Entitled ~7.am_na!~_~ finance Reform~. Via The Addition Of Code Section 2-490 EnflUecl "Prohibited ~am_na_)nn ConOlbutions By Lobbyists On Real Estate Develooment Issues~: Are you ~vina on a uendina a_n~_!_~u~eian for a Develoement Aumement with the atv or Off OCTOBER 1sT OF EACH YEAI~ EACH ~ S~'IALL SUBMIT TO THE C2TY ~"~ ~JC A S~NED STA'I'~4EKT UNDER OATH, LZSTZNG LOBBYZNG EXPENDZTURES I'N THE C~Y Of: HZA/q! BEACH FC~ THE PRECEDZNG CALENDAR YEAR. ! do solemnly swear that all of the~oregoing fact~ are true and correct and that ! have read or am familiar with the pmvision;~,ee~afned in S/acting-482 of the Miam~ch City Code as amended, and all rep°rtlng requirements' ~Z Signature of Lobbyist: /L///~i ~._,,~, ~,~/~ .6~,,~-------~. ,/7/ ~ - Form of S~GNATURE AND STAHP OF NOT.~Y OR DEPUTY ~'~ K'D.K: State of Rodda, County of Miami4)ade Sworn mend subscribed before me This~ day of ~ 2003. Signature of Public Notary - State of Rodda Print, stamp or type name of Notary Public Registration: [ L,]/ACCEF~ tO [ ] RE3EC~ eD DATE: 2' ~'/' ~ Registration fee 10aid: [ ] Yes [ ] No [ ~ [ ] ~ MCR # 2nd Revision 3/~.8/03 F:\CLER~lA'll.~oM~yls~egtslr*~k~)3.doc Bloomberg, Ronald 420 Lincoln Road Ste 448 Miami Beach F1 33139 Sieger, Charles 5996 SW 70th Street Miami Fl 33143 Suarez, Jose 5996 SW 70th Street Miami F133143 Gaines, Ron 5996 SW 70th St Miami F1 33143