HomeMy WebLinkAboutCharles J. Schweickert/ Carmen
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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 a~ 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:
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TELEPHONE NUMBER:
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FAX NUMBER:
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LOBBYIST RETAINED BY:
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NAME OF PRINCIPAl./CUENT:
BUSINESS NAME AND ADDRESS
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TELEPHONE NUMBER:
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(Number and Street) (City) (State) (Zip Code) .
30..5- - r;?a.. /073 el'1A!./'fCJ1)fl.;z.::2. 2> ;'1-ot-. e"!!1
FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal Is a Corporation, Partnership or Trust [Section 2-482 (c)]
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
. IDENTIFY All PERSONS HOLDING, DIRECTlY OR INDIRECTlY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II.
SPECIFIC LOBBYlSSUE: /0 Pit- () VI /Je;' ~ I h rCo""t::-/"VIl. /f"~ /f7U j} c= CP A-/l> N./ C->
IJ7V;?--L.. V 6 IS I If} :; tJ fJ f ~ It. r tJ /-::: II-fd" ~ /I7f1V ~ &" t>;:= fij7'1-n/~
Issue to be lobbied (Describe in detail):
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III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOUR! Y,
FLATRATEOROTHERt. ~
A) LOBBYIST DISCLOSURE: (Required) ? ? 11;) ~ ~
,
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). , 3 ~ /.5' ~'"7 4t:.-.
with
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1)
Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaion Finance Reform" Via The Addition Of Code Section 2-48B Entitled "Prohibited
Camoaion Contributions Bv Lobbvists On Procurement Issues":
DYes MNo:
Are YOU lobbyina on a Dresent or oendina bid for aoods. eauiDment or services. or on a Dresent
or Dendina award for aoods. eauiDment or service?
2)
Pursuant to Ordinance No. 2003-3395 Amendino Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaion Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaion Contributions Bv Lobbvists On Real Estate Develooment Issues":
DYes 'NO:
Are YOU lobbyina on a Dendina aDDlication 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 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 EXPENDIT RES 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.
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Signature of Lobbyist:
Signature of Principal/Client:
VI.
~BBYIST IDENTIFICATION:
r/producedID ~l~~ lA~
Form of Identification
PRINCIPAL IDENTIFICATION:
o Produced ID
II Personally known (Lobbyist)
Form of Identification
~nallY known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Swam and subscrib before me
This g~ day of ,20~f
SYLVIA KENNEDY
MY COMMISSION. 00 257809
EXPIRES: February 10, 2008
Aonded ThN NdoIy NlIic_
, SYLVIA KENNEDY
MY COMMISSION. DO 257M9
EXPIRES: FBbtuary 10, 2008
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/ FOR CLE
Annual Registration fee: [ ] Yes [ VI No Amount Paid
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F: CLER\ALL
, USE ONLY
. MCR #d~3C:>Date Paid ( Cy 10 · D<<-4
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