HomeMy WebLinkAboutBruce Rogow / Clay Hotel
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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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BUSINESS NAME AND At>DRESS (Number and Street) (City) (State) (Zip Codel:' ~de...dc4
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TELEPHONE NUMBER: FAX NUMBER: EMAIL: ~~~ 9V
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LOBBYIST RETAJNED B;":II
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NAME OF PRINCIPAl/CLIENT:
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(Number and Street)
M . ~r4.
(State)
(Zip Code)
'73
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:
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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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,SPECIFIC LOBBY ISSUE: ,M '
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Issue to be lobbied (Describe in detail):
In. CITY AGENCIES/INDMDUALS 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,
FLAT RATE OR OTHER): ""if. .
A) LOBBYIST DISCLOSURE: (Required) (~ 0~".II /~/4#14(, J...J.1 (M...I'
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
ensation or
1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Campaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaign Contributions Bv Lobbyists On Procurement Issues":
2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Campaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions By Lobbvists On Real Estate Develooment Issues":
V. SIGNATURE UNDER OATH:
.' ON OCTOBER 1ST O'F EACH YEAR, EACH LOBBYIsT SHALL SUBMIT TO THE cm 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 COMP SATION DURING THE
REPORTING PERIOD.
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I do solemnly swear that' an of the foregoing.facts are true and coiTed' and that I have read or am
familiar with the provisions contained in Section -482 of the Miami Beach City Code aod all reporting
requirements.
PRINCIPAL IDENTIFICATION:
produc~ I~~' bb~:~ tteJr./3o- -;b>) -3C( - ~M-t
Form of Identification
Signature of Lobbyist:
Signature of Principal/Client:
LOBBYIST IDENTIFICATION:
ProducedIDll' !)rIll' ;;:Z.CO-()77-31r
Form of Identification t/;23--o
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
VI.
Personally known (Principal)
State of Florida, County of Miami.Dade
Sworn to and subscribed before me ..r.... I
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/Signature of Public Notary - State of Florida
Notarization of Lobbyist's signature
State of Florida, County of Miami-Dade
Sworn and subscribed before me . (
This I if day of t0ch&,.f . 20Q."t
Signature~~
Notarization of Principal's signature
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PAULA CAlDERON :
.~. ComInIDrarU'2lI.
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~~ Ullam R Hatfield .
, . . My CommiSsion DDOO2020
'+.....tI Expire. February 18, 2005
./' FOR CLERK'S USE ONLY
Annual Registration fee: [vi Yes [ ] No Amount Paid i) 'lV MCR # ?1? 'ill (P Date Paid
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F: CLER\AL ARIA-M\LOBBYIST\LOBBY1ST FORM 04
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