Bruce Weil/136 Collins Ave LLC
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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 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, 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
principal as well as any employee engaged in lobbying activities. The term ftLobbyistsM has specific exclusions. Please refer
to Ordinance 2004-3435.
BUSINESS NAME AND ADDRESS
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TEL&HONE NUMBER:
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(Number and Street)
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(First)
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(City)
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(State)
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EMAIL:
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(Zip Code)
NAME OF LOBBYIST:
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(Last)
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FAX NUMBER:
I. LOBBYIST RETAINED BY:
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NAME OF PRlNCPAl./CUENT:
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BUSINESS NAME AND ADDRESS
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(Number and Street) (City)
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(State)
(Zip Code)
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)l
.
NAM~ CHIEF OFACER, PARTNER, OR BENEACIARY: .
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IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
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II.
SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
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A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
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1)
Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach Citv Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaiqn Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaion Contributions Bv Lobbvists On Procurement Issues":
DYes~
Are you 10bbvinG on a Dresent or DendinG bid for Goods. eGuiDment or services. or on a Dresent
or DendinG award for Goods. eGuiDment or service?
2)
Pursuant to Ordinance No. 2003-3395 Amendino Miami Beach Citv Code Chaoter 2. Article VII Division 5
thereof Entitled "Campaion Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaiqn Contributions Bv Lobbvists On Real Estate Develooment Issues":
V.
SIGNATURE UNDER OATH:
ON OCTOBER 15f 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 EXPE URES OR COMPENSATION DURING THE
REPORTING PERIOD.
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. (
VI.
LOBBYIST IDENT!EICATION: I . II:
F/..:'y~:';el?~ ""~M.~e.
..-.( Produced ID :r 5~-731-""'-;.l.J.7~
Form of Identification
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Signature of Lobbyist:
Signature of Principal/Client:
PRINCIPAL IDENTIFICATION:
lJ Produced ID
:, Personally known (Lobbyist)
Form of Identification
~rSOnallY known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This JO-tt<.. day Of~ 201>"/
Sig e of Public Notary - State of Florida
~Sl ature
~IIOOI NOISSII'lI'KlO AI'l r:;~*V'"
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133~rmN NOISSII'lI'KlO 0 i5~, It
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i1l<>>t'1'!'Ob~ "d 4~
State of Florida, County of Miami-Dade
swor\ ~d subscriQed before me
This day of '~Y\f... , 2~
Signature of
Notarizati n
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~o~\1f'"0 MAflGARElTA PWIEDA
... : I ~ COMMISSION NUMBER
7. fi 00121865
1:-0 oq. MYCOMMtSSIONEXPIRES
Ff\. ..__.,...~A Y 30.2006
FOR CL
Annual Registration fee: [ ] Yes [t;...fNo Amount Pai
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F: CLER\AL
.b~;~ # P7tP$i;ate Paid