Anthony Albelo / Mark Blackburn
Miami Bcio1d1
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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; r 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 "Lobbyistslr has specific exdusions. Please refer
to Ordinance 2004-3435.
Albelo Anthony
NAME OF LOBBYIST: (Last) (First)
Envision Consulting, 3300 Rice Street, Suite 11, Miami, FL 33133
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
(M.!)
(Zip Code)
(305)461-2700
TELEPHONE NUMBER:
(305) 445-6179
FAX NUMBER:
aalbelo@envision-usa.com
EMAIl:
I. LOBBYIST RETAINED BY:
Mark Blackburn, V.P.
NAME OF PRINCIPAL/CUENT:
Worldwide Motorcycle Shows - Miami, 3300 Rice Street, Suite 11, Miami, FL 33133
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)445-1316
TELEPHONE NUMBER:
(305) 445-6179
FAX NUMBER: (Optional)
mblackburn@bikeweekmiami.com
EMAIL: (Optional)
Fill out this section if principal is a'Corporation, Partnership or Trust [Section 2-482 (c)]
NAME OF CHIEF OFACER, PARTNER, OR BE NEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
VCA Grant Request for February 2005 motorcycle show at the Convention Center.
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
VCA
No
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER) :
A) LOBBYIST DISCLOSURE: (Required) None 0
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). None 0
DYes !l No: Are YOU reDresentinG a not-for-Drofit col'DOration or entity without soecial comoensation or
~
reimbursement. Pursuant to Ordinance No. 2004-3435.
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":
o Yes Xl No:
Are YOU lobbyinG on a Dresent or oendinG bid for Goods. eauiDment or services. or on a Dresent
or oendinG award for Goods. eauiDment or service?
2)
Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Campaign Finance Reform". Via The Addition Of Code Section 2 -490 Entitled "Prohibited
Campaign Contributions Bv Lobbvists On Real Estate Development Issues":
DYes lG No:
Are yOU lobbyinG on a oendinG aDDlication for a DeveloDment AGreement with the City or
aDDlication for chanGe of zoninG maD desiGnation or chanae to the City's Future Land Use MaD?
SIGNATURE UNDER OATH:
v.
eN OCTOBER ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTlNG 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 EXP NDITURES OR COMPENSATION DURING THE
REPORTING PERIOD.
re of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
ilmiliar with the provisions cont ned in ion -482 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
o Produced ID
o Produced ID
Form of Identification
Form of Identification
Jt Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
(Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn to and subscribed before me ~
This (b day of S'AtJ ,20th
State of Aorida, County of Miami-Dade
Sworn (;d subscribed before me
This day of ~~ .20.J2c..r-
'\
"
li"\""'~\ DAVID P. RYAN
'*i }"1 MY COMMISSION # DO 180375
~'.. .~l EXPIRES: January 27, 2007
iif.. , \\ Bonded Thru Nolary Public Undelwriters
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Signatufi
Nota za. cipal's signature
$~~' DAVID P. RYAN -~,-
i*!~A"l J1 MY COMMI~'ON t DO 180375
\~~: EXPIRES. January 27, 2007
''1.;r.~~- Bonded Thru Notary Public Underwriters
Annual Registration fee: [~.... Am
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F LER\