Stuart Grossman 01/28/04City of Miami Beach Office of the Ob/Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: dtyclerk@d.miami-beach.fl.us
LOBBYt'ST REGZSTRATZON FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
O Check Box if an Amendment
NAME OF LOBBYIST: (Last) (First)
BUSINESS ADDRESS: ('NumbEr afld Street) (City) O '
TELEPHONE NUMBER: FAX NUMBER:
(M.I) DATE QUALIFIED AS LOBBYIST
(St'ate) (Zip CodE)
~L:
I, LOBBYIST RETAINED BY:
NAME OF P~NOPA~C~ENT:
BUSINESS ADDRESS: (Number and Street) (Ci~) (S~te)
~LEPHONE NUMBER: F~ NUMBER: (Optional)
(Zip (::ode)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
· NAME OF CHIEF OFFICER, PA°,TNER, OR BENEFiCiARY: ~
· I]ST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5 ¥o OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP ORTRUST:
II, SPECIFIC LOBBY ISSUE:
Issue t~ I~ Iobbied~Describe in det~J):
III. CI'I'Y AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/TiUe B) Relationship
U
01-1~-zn04 ln:~3AM FROM-TEW CARDENA$ REBAK +~055551115 T-7'E8 P.O0~/O03
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B) PRINC~PAU$ DISCLOSURE ('OF LOBBYIST CONPENSAI'~ON): ~. I ~ ~ / It~4,'~-
l)
2)
. Pursuant to Ordinanc~ Nh. 2003-3393 Amendincl Miami Beach Ciw Code Ch~lpter 2, Article VT[. Division ',
Thereof Eq~;]l~led-Campaign FinaB~ ReR~rm" Via T11e Addition Of Code
Camoaian Cor~tribution$ Bv Lobbyists On procurement I~U¢,.~"
Are you Iobbvin~ on a r~resent ar pendin~ bid for e00ds, eeuiament or services, or on a present
or pending award for aood~, equipment or service?
Pursuant to Ordinance No. 20~13-339S Amendina Miami B~.ach CjW Code Chapter 2, Article V~I Division 5
~hereof Entitled "Campaiclri Financ~ Refor~il", Via The Addition Of Code .~.ctioil 2-4g0 Entitled ,~prehiDit~.,
Cam~aien Contributions BV Lobbyists On Real E-~.ate Drive o~r~ent Issues":
Are you Iobbvin~ on a oendinq application for a Oevelooment Aqreement with the City ~,
aonlication for change of zonine malLctesiqnation or chanqe to the Citv'~ ~uture Land Use Map?
Yes No
V. SIGNATURE UNDER OATH:
ON OCTOBER 1s~ OF EACH YEAR~ EACft LOBBYZST SHALL SUBMIT TO TIdE (,~IY CLERK A SZGNED
STATEMENT UNDER OATH, LZ'~'f~NG LOBByTNG EXPENDZTURES ZN THE C~TY OF MZAM! BEACH FOR
THE PRECEDZNG 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 2-4-82 of the Miami Beach City Code as amended, and ali
reporting requirements,
Signature of Principal/Client: 1~/~ .~ ~ ~
V~, LOBBYIST IDE NTZFZCATION:
Produced ID
Form of Identification
SZGNATURE AND STM~IP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of MiamFDadez
Sworn to apd subscribed before me
(~Sig~ture'of P~blic Notary- State of Flor(da
Prat, stam~ ~r ~pe name of No~ Public
FOR CLERK'S USE ONLY
Registraaofl: ED [ ] RE]ELl'ED DATE:
I? rejected, state reason: /'/ ./ ,,~ / /
Registration fee paid: [/%]-~es [~ ] No [ ] Cas~ .
Revision 3/18/D3 / ! F;\CLE~HAff'L\Lobbyis[s\registratianaO3.doc
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
1)
2)
Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2, Article VII, Division S
Theregf Entitled "Campaiqn Finance Reform" Via The Addition Of Code ~ction 2-488 Entitled "Prohibited
Camoaian Contributions Bv Lobbyists On Procurement Issues":
Are Y~U Iobbvina on a aresent or oendinq bid for aoods, euuioment or services, or on a oresent
or pendinq award for qoods, e~uioment or service? Yes No
Pursuant to Ordinance No. 2003-3395 AmendinQ Miami Beach City Code Chapter 2, Article WI Division 5
thereof Entitled "Campaiqn Finance Reform", Via The Addition Of (;ode Section 2-490 Entitled "Prohibited
CamDaion Contributions Bv Lobbyists On Real Estate Develooment Issues":
Are you Iobbvin= on a oendin= aoolication for a Develooment Aoreement with the City or
application for chanqe of zoninq map desiqnation or chanqe to the City's Future Land Use Mao?
Yes NO
V. SIGNATURE UNDER OATH:
ON OCTOBER IsT OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE C~ IY CLERK A SIGNED
STATEMENT UNDER OATH, L1S~NG 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:
LOBBYIST IDENT~F~CATLON:
[] Produced ID
Form of Identification
Personally Known
WI. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of MiamFDade
Sworn to and subscribed before me .
This c~,~/ct day of~ 200~.r
-SignatUre of Pubii/~/N-otary - St~t~ ~)f Flodda
Print, stamp or typ~ name of Notary Public
Registration: [ ] ACCEPTED
If rejected, state reason:
Registration fee paid: [ ] Yes [ ] No
DATA ENTRY DATE:
2nd Revision 3/18/03
FOR CLERK'S USE ONLY
[ ]RE]ECTED DATE:
[ ]Cash [ ]Check MCR#
,2003 ENTERED BY:
F: \CLER\HATL\Lobbyists\regislzationa 03.doc