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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRA nON 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 "LobbVists" has spectic exclusions. Please refer
to Ordinance 2004-3435.
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TELEPHONE NUMBER:
(Number and Street)
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FAX NUMBER:
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(First) (M.I)
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(City) (State) (Zip Code)
C.A~S e? '7f;e.lUr S7VdrO
EMAIL:
NAME OF LOBBYIST:
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BUSINESS NAME AND ADDRESS
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(Last)
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I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CLIENT:
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BUSINESS NAME AND ADDRESS
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TELEPHONE NUMBER:
(Number and Street) (City)
3tJrr. '?~ If ~1Z-
FAX NUMBER: (Optional)
(Zip Code)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFIOARY:
CA/l.~5 ;::'/-tP-' /&J(,J'ie-7'
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% 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. CI1Y AGENCIES/INDIVIDUALS 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):
A) LOBBYIST DISCLOSURE: (Required)
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ;::-AAY '#-,{';0 # ~#4/n'C"'-
r"-A- -r ftlJ '"7't" AS. A;t.VI cti7
,
1)
Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2. Article VII, Division 5
Thereof Entitled "Campaign Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Campaign Contributions By Lobbyists On Procurement Issues":
Are :~: 10~~i:: ~n a Dresent or oendinG bid for Goods. eGuiDment or services. or on a Dresent
or oendinG award for Goods. eauiDment or service?
Yes
(;7
2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5
tbereof Entitled "Campaign Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Campaign Contributions By Lobbvists On Real Estate Development Issues":
V. SIGNATURE UNDER OATH:
ON OCTOBER 1 Sf OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, UmNG LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDA YEAR. STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXP RES OR' ENSATIO. URlNG THE
REPORTING PERIOD. .'
I do solemnly swear that all of the foregoing facts are true and correct and t t I have read or am
familiar with the provisions contain ion 2- 2 of t Miami Beach City Code and all reporting
requirements.
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
Signature of Lobbyi
Signature of Principal/Client:
Produced IDr/ if/;' I/c, 7~3f}./lr. ST40O\{-S-~Uced 10
Form of Identification
Personally known (Lobbyist)
Sign ure of Public Notary - State of Florida
Notarization of Principal's signature
VII. - SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This / r day of .,At d1 J , 20 Ql--/
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Signature of Public Notary - State of Florida
Notarization of Lobbyist's signature
~."._._-_.....
PAULA CALDERON .
- _OD_
~ -'::.n_7i-:ad
FOR CLERK' USE..QNL Y b4
Annual Registration fee: [~[ ] No Amount Paid OUMCR #;1 7:;2tJ ~/ Date Paid
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F: CLER\ALL\MAR - OBBYIST\LOBBYIST FORM 04
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