James R. Robinson/Leo Schigiel
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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 prindpal 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, dedslon or recommendation
that foreseeably will be heard or reviewed by the city commission, or a city board or committee. The term specifically indudes the
principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer
to Ordinance 2004-3435.
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NAME OF LOBBYIST: (Last) (First)
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BUSINESS NAME AND ADDRESS (Number and Street) (City)
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TELEPHONE NUMBER: FAX NUMBER:
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I. LOBBYIST RETAINED BY: .
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NAME OF PRINCIPAl/CLIENT: .'
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(State) , (Zip Code)
EMAIL:
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BUSINESS NAME AND ADDRESS ,. (Number and Street) (City) (State) (Zip Code)
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TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
. NAME OF CHIEF OFACER, PARTNER, OR BENEACIARY:
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II.
SPECIFIC LOBBY ISSUE: ",,,tJA!I, Plv,1i6 ~~.
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Issue to be lobbied (Describe in detail):
III. CITY AGENCIEs/INDIVIDUALs TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER). .p
A) LOBBYIST DISCLOSURE: (Required) 'ZS'
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ~
D Yes ~ Are vou reDresentinQ a not-for-Drofit corDoration or entity without sDecial comDen5ation or
reimbursement. Pursuant to Ordinance No. 2004-3435.
1)
Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach City Code Chapter 2. Article VII. Division 5
Thereof Entitled "CampaiQn Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
CampaiQn Contributions Bv Lobbvists On Procurement Issues":
DYes ~
Are you lobbvinQ on a Dresent or Dendina bid for Qoods. eQUiDment or services. or on a Dresent
or Dendina award for Qoods. eQUiDment or service?
2)
Pursuant to Ordinance No. 2003-3395 AmendinQ Miami Beach City Code Chapter 2. Article VII Division 5
thereof Entitled "CampaiQn Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Campaion Contributions Bv Lobbyists On Real Estate Development Issues":
DYes
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 EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD. ~ ....
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..- Signature of lobbyist
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 and all reporting
requirements. ~ ~
Signature of LO~hr'8L. ~:--: ~ ~'
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VI. LOBBYIST IDENTI~ PRINCIPAL IDENTIFICATION:
[J Produced ID
o Produced ID
/ Form of Identification
vPersonally known (Principal)
Form of Identification
j Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
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%.J'9.' "1.~$4'~loRCLERK'S USE ONLY
Annuai Registration fee: [ ;;'jll>&'c';;t~ O~,~ount. Pai? l~, r~) MCR # Z l"v, D~Date Paid
lobbyist Registration Form receiq~llMt~'cl by: LIlI,!b;) 1St'I~ULWl~
Revised 02/10/04 F: ClER\All\MARIA-M\lOBBYIST\lOBBYIST FORM 04
Si of
Notarizatio
State of Florida, County of Miami-Dade
Sworn to and subscribe before me J?Y
This I:::L day of I 20 [)
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