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Art Edelstein/Festival Prod. I';'-"~ "1iami BeiKh m bftd qnr - 2JJU3 - 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 wili 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. EDE'LSTEI t-J NAME OF LOBBYIST: (Last) ,b.R. T (First) e. (M.I) t=eSiNA:L PrZOt)uc...TIO~IS. '''-If' 311 vJ"I..f1J:lST. BUSINESS NAME AND ADDRESS (~umber and Street) (City) New yoet::.., NY I {)()A1 ~ (State) (Zip Code) (&1 a) 7qq- ,~(Ol J) o.(i.ede.\.~in @.+piny.c.olVj FAX NUMBER: EMAIL: (61I~) 4-q<o -q DOa 11 13q9 TELEPHONE NUMBER: I. LOBBYIST RETAINED BY: FESjtllAL Pe.oD\'x::"Tl DtJS I I !oJ e... NAME OF PRINCIPAL/CLIENT: 311 w. 7L1TI-1 ST. BUSINESS NAME AND ADDRESS (Number and Street) N tw voe.:'t" (City) I\.IY (State) IODa3 (Zip Code) (.;tl;;)) 4Qw- QOOe" 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: GEOe.GE: "" e; I N IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: veA. GIZ.A.t>..l"" R:>~""THe .JV(' .\f1..-u... FIESTh'....L- ,,^IA MI .B~~~ Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship M\,o.,M I Bel>.c..-l-\ V 1'S ,TOe to-ND C'.bNVE:l-J'TlcN .6.lrr.' -" IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLA T RA TE OR OTHER). A) LOBBYIST DISCLOSURE: (Required) ~ (/) B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required), :$ 9'> 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": n Yes )l No: Are you lobbvina on a oresent or oendina bid for Goods. eauioment or services. or on a oresent or oendina award for aoods. eauioment 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.. 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 EXPENDrJ: 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 ~~2~ of the Miami Beach City Code and all reporting requirements. r I r fI-' .~ Signature of Lobbyist: ~ J1T~ ~ ~d ..e Co ,. ::JC\I 001 8.; ~~ii~ 'CD"".c"'" :X:1a~()1IJ :x:-o'tDl! ~ 00 a:: CD'- o.2o~.n- m.gci:Qc Wo.Z(\).2 Q~ ~IIJ _IIJ 'ii'- a ::JE z oS Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: D Produced ID D Produced ID Form of Identification ~ 9 z ~ Personally known (Lobbyist) li,~ ! VII. SIGNATURE AND STAMP OF NOTARY: CD 0 N~'1ol't-- \tJe.\4-~~~ Ne..JYQfL WIVj-h.~t<-....-- Q. Z 'l m;tate of-flefitlil, County of~4ial'lli blase'" State of Fi'aril!Ie, County oM!;"",,; Salle {IlS" P S!: worn to and subscribed before me Sworn a~ subscribed before me '6~gj5' '~dayofJ"""" ,200~ ThiS~O~ i ! f i ignature of Public Notary - State of-Fletoiele NtA-i Signature of Public Notary - State of PIefiea /lJe,..,..J Y c" IL f I ~ 9. ~otarization of Lobbyist's signature Yor Ie.. Notarization of Principal's signature !:J. 9t !i z C" ./ FOR CLERK'S.USE QNL Y , !>- 0 I c ~nnual Registration fee: [ o Yes [ ] No Amount Paid I bO ,(}J MCR # ::z 7 3842eate Paid I, 6/ c8' I\) ~ Lobbyist Registration Form received and verified by: ./WJ o i ~ F:\CLER\$ALL\MARIA.M\Lobbyist\LOBBYIST fORM OS,doc Revised 12/0B/04 ~ Form of Identification ~ersonally known (Principal)