Robert Goodman/Bert Vidal
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. City of iami Beach Office of the City CIlilrk
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 decision 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, dedsion or recommendation
that foreseeably will be heard or reviewed by the city commission, or a dty board or committee. The term specifically indudes the
prindpal as well as any employee engaged in lobbying activities. The term "LobbylstsH has specific exclusions. Please refer
to Ordinance 2004-3435.
Goodm0V7 J
NAME OF LOBBYIST: (Last)
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BUSINESS NAME AND ADDRESS (Number and Street) (eity)
.(~~?~7.3-5/77 ?,t?~) ~73 - /24Z
LEPHO E NUMBER: FAX UMBER:
~6er/
(First)
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S.
(M.I)
. ,3/'ct -v5 /"L
State) (Zip Code) :.:E/~
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7' EMAIL: -Y ~~H~hJ
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAl./eUENT:
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( ity)
Cqt2~), ~-:?4- Fff?7
FAX N MBER: (Optional)
(State) (Zip Code)
bY/dN/~k7fO.rJr;vy?(~-!,~ .~
EMAIL: (Optional) .
Fill out this section if principal is a Corporation, Partnership or Trust [SectIon 2-482 (c)]
.
NAME OF CHIEF OFFIeER, PARTNER, OR BENEJ;ICIARY:
.
, :, \
IDENTIFY ALL PERSONS HOLDING, DIREcrLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
eORPORATlON, PARTNERSHIP OR TRUST:
'.,
II. SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe In detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Indlvidual/Title B) Any Financial, Familial or Professional Relationship
"
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOUR! Y,
FLA T RATE OR OTHER).
A) LOBBYIST DISCLOSURE: (Required) $5 ~ - a/J/J L/d' / ;;;.~,
B) PRINCIPAL'S DIseLOSURE (OF LOBBYIST COM;ENSATION): (ReqUired),JS.al1O tl~iA'V \ ~ J
DYes XNO: Are YOU reDresentina a not-for-Drofit corDoration or entity without sDecial comoensation or
reimbursement. Pursuant to Ordinance No. 2004-3435.
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 Bv Lobbvists On Procurement Issues":
ent or servic
2)
Pursuant to Ordinance No, 2003-3395 Amendina 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 Lobbvists On Real Estate Deveiooment Issues":
DYes >>0:
Are vou lobbyina on a,Dendina aR!!lication for a DeyeloDment Aareement with the City or
aDDlication for chanae of zonina maD desianation or chanae to the City's Future Land Use MaD?
v.
SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF' EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING IjXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING C DAR YEAR. A STATE
SHALL BE FILED EVEN IF THERE HAVE BEEN NO ~PE U E MPENSATION DU
REPORTING PERIOD.
Signature of Lobbyist:
Signature of Principal/Client:
PRINCIPAL IDENTIFICATION:
/produced ro,.c'L )}..; rrrs. .6'ao/?Sc...
....d- c '"l '"l FOIIJ1 of IdentificID;ion
--- ~o(. c.. -If" - SS - 4l/3- 0
[] Personally known (Principal)
VI. LOBBYIST IDENTIFICATI
'" Produced ro",""L ))r;VfO-'''' iJ~
~..c~ Form of Identificatipn
--q-:f55- ??? -39-.3c;~ - 0
iI Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me _~"
This \ 3 day of Na'(c..h . 2~
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Signature of Public Notary - State of Florida
Notarization of Lobbyist's signature
."'~'.'t, Marisa Bluestone
~ ~ ~ My Commission CC989850
W""",'-' EXlIires December 25. 2004
Signature of Public Notary - State of rida
Notarizati~ of Principal's signature
_.. SIISlID Christa Johnson
I ~CommlssiOD # DD081888
S' . E JIz:plres JIIIL 29, 2006
iil'J! $ IoD.dK Thru
.g{,~ A1:IanIic Bonding Co., Inc.
FOR CLERK'S USE ONLY ,t! /
Annual Registration fee: [ ] Yes [ ] No Amountpaid 1lfS' 00. MC~ # ,2..(,(., 0 '71' Date Paid ""tf 11 04-
Lobbyist Registration Form received and verified by: ~4-/ W ilI_____
Revised 02/10/04 F: eLER\ALL\MARIA-M\LOBBYIST\LOBBYIST FORM 04