HomeMy WebLinkAboutAva J. Borrasso/Oceanside
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM~I
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 "LobbyistsH has specific exclusions. Please refer
to Ordinance 2004-3435.
.Bon't\ S SO
NAME OF LOBBYIST: (Last)
.A,
A\S "
(First)
.:r:-
(M.I)
d- Fl. 'l f(., 3l)10
(Stat (Zip Code)
C\ ~V'.....O\s.ro (~ Shl) IcJ~~cS's.
EMAIL: CtJ ~
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BUSINESS NAME AND ADDRESS
(City)
30$1 521\-0,'-15"7
. FAX NUMBER:
305/3~1- bO(Oc..>
TELEPHONE NUMBER:
I. LOBBYIST RETAINED BY:
Or~",S; J ~ o.-LF1~&.- \ ')C;""d. Co",-clo ill S~ n No.5, I h c..
NAME OF PRlNCIPAL/CUENT:
J F1Sh,g.,- 1 s/~V\ c!. VY\\,'-R I FrS~r lsl~~) . Qc
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
305/5.3 7... -3Jl./L.J
TELEPHO,(E NUMBER:
33 I 0 1
(Zip Code)
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 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
r t s Jc.~t 01'" j\J'e..
Fd.c. V"o.
CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
'0"')
.
III.
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). iI
A) LOBBYIST DISCLOSURE: (Required) 300.00
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
1)
Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2, Article VII. Division 5
Thereof Entitled "Camoaign Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions By Lobbyists On Procurement Issues":
2)
Pursuant to Ordinance No, 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Campaign Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoai9n Contributions Bv Lobbyists On Real Estate Develooment Issues":
,
, ,I,
DYes 1i)Nb:
Are you lobbyinG on a DendinG aDplication for a DeveloDment AGreement with the City or
aDDlication for chanGe of zonina maD desiGnation or chanGe to the City's Future Land Us.e MaD?
SIGNATURE UNDER OATH:
V.
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.
a
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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
requ irements.
PRINCIPAL IDENTIFICATION:
Signature of Lobbyist:
Signature of Principal/Client:
VI.
l-J Produced ID
II Produced ID
Form of Identification
~rSOnallY known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
Form of Identification
~n'IIY known (Principal)
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State of Florida, County of Miami-Dade
Swo,!A ~ subscribed tr,fore me .,.,j
ThisU-day of ~ ~ ' 20~ (
~gn.ture~~.
Notarizat :\ f Pr ipal Q~ /'
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~ J~. '.'O..i.'.'.M ISS. ION. . NU.M. B SR
I ~ fJ 00036311
, (:' 0 o~ MY CDMMISS/ON EXPIRes
.,~=~ E [0\'=.. -. ,J_ll.':rJ3,2021==:,
~ FOR CLERK'S USE ONLY Y.
Annual Registration fee: [ es [ ) No Arno t P 'd' MCR #};). 71 5'7 Date Paid
Lobbyist Registration For ceived and verified by:
Revised 02/10/04 F: CC R ARIA-M\LOBBYIST\LOBBYIST FORM 04
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