David Sacks - HPB 2672
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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 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.
PorlS'
~ (Last)
c::<
(Number and Street)
/):;v/d
( First)
~
(M.!)
,--3OS: 37 9~dtj~5
TELEPHONE NUMBER:
L?O)' .-3:J--9 - O?L/c?O
FAX NUMBER:
Fl53BJ
( tate) (Zip Code)
nc:5 fiJ 1hI/;JrY?n/~wi5. 80m
EMAIL:
I. LOBBYIST RETAINED BY:
Oo~ Hrwe enll ,%ulh 6rcb ' U (!
NAME OF PRIN IPAl./CLIENT:
/1// (c1/1/7S
BUSINESS NAME AND ADDRESS
.9)5". {()v- 3~l/:;
TELEPHONE NUMBER:
P//r-/1t/P /t!/OA /; '~h
(Number and Street)' (City)
R-
(State)
3359
(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 OFFICER, PARTNER, OR BENEFICIARY: llrcl~tLJ J: rO)'l"J:?t
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: /J"l--i J/
/7/dl?t<.J ~ro~,r
II.
.e.-
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
. ~ /J;
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER). · ,
A) LOBBYIST DISCLOSURE: (Required) 11 .3:95" I J ~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATI~): (Required). ~ II ,~,- / J c?s()
I
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
DYes
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
Yes D No:
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of a not-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees..
DYes
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 EX S OR COMPENSATION DURING THE
REPORTING PERIOD.
I do solemnly swear that all of the foregoing facts a true and correct and that I have read or am
familiar with the provisions amtaffi . Section 2 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyis '
Signature of Principal/Client:
Signature of Lobbyist
VI. LOBBYIST IDENTIFICATION:
~. Produced ID
orm of Identification
PRINCIPAL IDENTIFICATION:
,X,[produced ID 'b ! L
Form of Identification
D Personally known (Lobbyist)
D Personally known (Princi al
....;ftr~'" LORI A. VeRGARA
ff':-';b. ~i:; MY COMMISSION # DD 054952
~::.~J<g EXPIRES: September 4. 2005
State of Florid -~~of Mi(!jffif!D'tJCle puti;e l;n:1er."it.rs
Swor~..eJl su
This/l/I
VII. SIGNATURE AND STAMP OF NOTARY:
FOR CLERK'S USE ONLY
Annual Registration fee: [ ] Yes [v(NO Amount Paid 60. cJD MCR # Z- 73 8'fB Date Paid I / II/DE>
Lobbyist Registration Form received and verified by: 1--1 u.J
F:\CLER\$ALL\MARlA-M\Lobbyist\LOBBYIST fORM OS.doc Revised 12/08/04
&
Mi;ami Bc-iKh
-
1lI0~
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 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, Tbe tenn "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
~{' r <;
~ (Last)
0:<
(Number and Street)
&I//C/
(First)
6:
(M.l)
aos: 379~OX/e:25
TELEPHONE NUMBER:
L ~ .-3:;-9- O?tj;;;O
FAX NUMBER:
17338/
( tate) (Zip Code)
{J65 tiJ IhIlvrnnLetoi5. {Jom
EMAIL:
I. LOBBYIST RETAINED BY:
.JJa~ HrJ.J<R enll ,C()u+h 8rch . (I (!
NAME OF PRI IPAl/CUENT:
///1 ~C1/)/7S
BUSINESS NAME AND ADDRESS
Pllr-nt/p ;t/;i?A. jl; -thz'h fZ
(Number and Street)' (City) (State)
3389
(Zip Code)
. ~s: (j)c/ - 304:;
TELEPHONE NUMBER:
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: ,lirdlFuJ i:rOl7l="r
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: /L i V.
nr t:/1'C"k.J /-rO/7'K:'F
II.
III. CITY AGENCIES/INDIVIDUALS 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 HOURLY,
FLA T RA TE OR OTHER). I
A) LOBBYIST DISCLOSURE: (Required) J ~ / J ~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATI~): (Required). \./1 ,.q;J:5" / J dsl'J
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
~ No: A;; ~ I~b~i~ ~n ~nt:cr :ndin~~ ~r;.o~:uioment or services. or on a
\ Dresent or DendinG award for Goods. eGuioment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of a not-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees..
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 EX S OR COMPENSATION DURING THE
REPORTING PERIOD.
I do solemnly swear that all of the foregoing facts a true and correct and that I have read or am
familiar with the provisions c . Section 2 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyis .
Signature of Principal/Client:
VI.
PRINCIPAL IDENTIFICATION:
?(Produced ID 'b I [
Form of Identification
~ Produced ID
o Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
FOR CLERK'S USE ONLY
Annual Registration fee: [ ] Yes [v1NO Amount Paid .5b. cY D MCR # 2... 73 8<fB Date Paid I tIll (}5
Lobbyist Registration Form received and verified by: 1-1 uJ
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc Revised 12/08/04