David Bercuson / Antonio Rizzi
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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 "Lobbyists" has specific exclusions. Please refer
to Ordinance 2004-3435.
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(Last)
~ID ~.&rli'I JSOA.\ e&
BUSINESS NAME AND ADDRESS
NAME OF LOBBYIST:
'L)A'II'D
(First)
qlo/J '5."J)4rv:t ALII) "1i.1/D. iI-/1'UJ W1A16M1 fL
(Slate)
(M,I)
33/St,
(Zip Code)
.Jo5: t/la. t'XJ/ A
TELEPHONE NUMBER:
(Number and Street) (City)
~"'7I'J' I'YJ/cq
F NUMBER:
~P"/~.J(1ilAA.~
EMAIL:
I. LOBBYIST RETAINED BY:
AN"T/hJIIJ 'fI; zz;
NAI'1I;QFfRINCIPAljCLIENT: ..........\""I.A
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BUSINESS NAME AND ADDRESS (N mber and Street)
(City)
(State)
(Zip Code)
TELE ONE NUMBER:
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-4B2 (c)]
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: S~FO.~o fiz-;7T'~
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
r E
I
n. SPEcmc LOBBY ISSUE: B34 OCli.b...~VE'. LU!.. vll!:ol.6r -G- Chf'i!; ~EE~n.. ~._.....
COOC\>\'t\OO<~ use ~~~\~'\'O ~2..~ .f..n-1E.~~~W\ElooCt' ~ \'TS .....IO.C....----=
~... "NoS: I \....,~ cJ;: lWi'L\t'JG>..l-' l!.~ ~ 'N\V-\ ......,......\0\ ~ 'aI-\"-'~(!~
Issue to be lobbied (Describe in detail): lZ.~S. fZ..f"-uu.-noN'S 4 ~...c.l-ICe'a.
In. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Indlvidual/T1tie
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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):
A) LOBBYIST DISCLOSURE: (Required) ..\.b,IZ.L" I ~.!=; fFp<. ~ I~'o. ;r?J
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Requlred),~-a.L,f J'<nnp~';.; ~~
I
Yes @ Are vau reDresentlna a not-for-Drofit coroaratian or entity without soeclal comDensatlon or
reimbursement. Pursuant to Ordinance Na. 2004-3435.
1)
Pursuant to Ordinance No. 2003-3393 Amendin" Miami Beach Citv Code Chanter 2, Article VII. Division S
Thereof Entitled "Camnai"n Finance Reform" Via The Add~lon Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Procurement Issues":
yes@
Are YOU lobbvinG on a Dresent or ending bid for Goods. eauiDment or services. or on a Dresent
or oendina award for aoods. eauiDment or service?
2)
Pursuant to Ordinance No, 2003-3395 Amendin" Miami 8each Citv Code Chanter 2, Article VII Division S
thereof Entitled "Camnai"n Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camnai"n Contributions By Lobbvists On Real Estate Develonment Issues":
y
A I In na n In a Ii . nfor Devel m A ementwlth h I or
aDDlicatlon for chanae of zonina maD deslanatlan or chanae to the City's Future Land Use MaD?
SIGNATURE UNDER OATH:
v.
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST 5 ALL 5UBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISllNG LOBBYING EX ENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE RING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXP. N RES OR COMPENSATION DURING THE
REPORTING PERIOD.
VI.
an correct and that I have read or am
Mia i Beach City Code and all reporting
I do solemnly swear th t
familiar with the provisi s
requirements.
Signature of Prin
-,
LOBBYIS
of Identification
PRINCIPAL IDENTIFICATION:
Produced JD Frx.. -It 'P):za:1axl. "". lZ5.v
Form of Identification
Personally known
bylst)
Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida,
Sworn ~ub I
This ~aay 0
II". J. NANOEZ
.0\ Notary Public - Stale of Florida
;~ :.;.J MyCommissionExpiresOct13,2006
'''{i .n"'~~~" Commission # DD104a.-76
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. ~ FORCLE~'SU~ONLY "'''2 f
Annual Registration fee: ("'T Yes [ ) No Amount Paid s<> MCR #/) P' (., lc>
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F: CLER\ALL\MARIA-M\LOBBYIST\LOBBYIST FORM 04
[Jate Paid Cj) Ii} Ii) cJ
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