Cesar Sabroso/ACT Productions City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat
or modification of any ordinance, resolution, action or derision of any commissioner; any action, decision, recommendation of the
City Manager or any city board or committee; or any action, decision or recommendation of any city personnel defined in any
manner in this section, during the time period of the entire decision-making process on such action, decision or recommendation
that foreseeably will be heard or reviewed by the city commission, or a city board or committee. The term specifically includes the
pdndpal as well as any employee engagedinlobbying activities. The term "Lobbyist~~ has specific exclusions. Please refer
NAME OF LOBBYIST: , .~ (Last) (First) (M.I)
BU,/SINE~SS NAME AND ADDRESS . (nNmber and Street) (Oty) / 7, (~tate) . (Zip Code)
TEEEPHONE NUMBER: ' ' FAX NUMBER:
I. LOBBYIS;g RETAINED BY:
NAME OF PRINCIPAL/ClIENT:
BI/PSINE~S NAME AND ADDRES~ (N~mber'a,nd Street) (City) / /~ (S/taLe) . (Zi~
TELEPHO~IE NUMBER: ' ~ ~AX NUMBER: (Opt'o a ) EMAIL: ~(Optional)
Fill out this aec'don if pfindpal is a Corporation, Partnership or Trust [Section 2-482 (c)]
· ' NAME O~, CHIEF OFFICER, PARTNER, OR BENEFICIARY: '~(gC~ q-0'~
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION' PARTNERSHIP OR TRUST:b
/-,.)ce ,
Il. SPECIFIC LOIJBY ISS, UE:
1
Issu~ to ~ Iobbi~ (~ in ~il):
III. ~ AGENCIES/IND~IDUA~ TO BE LOBBIED:
A) Full Name ~ Individual/TiUe
B) Any Financial; Familial or Professional Reli~il~ r'
I'V. DZSCLOSURE OF TERMS AND AMOUNTS OF LOBByt'ST COMPENSATrON (DZSCLOSE WHETHER I. IOURL Y~
FLAT RATE OR OTHER):. '~
A) LOBBYIST DISCLOSURE: (Required) ~ ~) ~- ~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). /~J ~ '~- ~
E] Ye~ ~ Are YOP reDresentina a not-for-orofit corooration or entity without seecial compensation or
reimbursement. Pursuant to Ordinance No. 2004-3435.
1)
Dve
Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach City Code ChaDter 2. Article VII. Division 5
Thereof Entitled "CamDaion Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Campaiqn Contributions Bv Lobbvists On Procurement Issues":
Are you Iobbvine on a present or Dendina bid for eoods, eauiDment or services, or on a present
or oendina award for aoods, eauioment or service?
2)
Pursuant to Ordinance No. 2003-3395 Amendino Miami Beach City Code Chaoter 2. Article VlI Division 5
thereof Entitled "Campaiqn Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Campaign Contributions By Lobbyists On Real Estate Develooment issues":
Are YO# Iqbbyina on a oendina aoDlication for a Development Aareement with the City or
applicPti0n for chanae of zoninn mad desianation or chanae to the City's Future Land Use MaD?
V. SZGNATURE UNDER OATH:
ON OCTOBER Isz OF EACH YEAR~ EACH LOBByI'ST SHALL SUBt41'T TO THE CTrY CLERK A SI'GNED
STATEHENT UNDER OATH~ Lt'STZNG LOBBYZNG EXPENDTrURES~ AS WELL AS COMPENSA'FZON
RECEI'VED, TN THE CI'I'Y OF Mt'ANt' BEACH FOR THE PRECEDZNG CALENDAR YEAR. A STATEHENT
SHALL BE FZLED EVEN t'F THERE HAVE BEEN NO EXPENDTrU~NG THE
REPORTt'NG PER/OD.
[ 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 and~all r/e~orting
requirements.
Signature of Lobbyist: ,
Signature of Principal/Client: ~ N~~TZO~."~ -~
VZ. LOBBYZST '~DENTTFt'CATZON: PRZNCIPAL
[] Produced TD [] Produced !D
Form of Identification Form of Identification
'~ersor~lly known (Lobbyist) L~.rS~onaily known (Principal)
V1~1'. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade State of Florida, County of Hiami-Dade
Sworn ,to_~nd subscribed before me £ Sworn ar~cl subscril~ed before me ,, ~
This [5'T dayjof ~,200~ mhis~dayof~f~ ,20~
~ture of ~blic Nota~- State ~ Flor,~'~;~..:~. :.:~ ~gnatur~;~o,;- State of FloJ~
~zation of Lobby(srs sig~tur~ ~,~;~ ~tari~n of Principal's signatu.
...
FOR CLERK'S USE ONLY ~ · ,~