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Harold Rosen / Beach Towing ~hlJlfTll tft!',ftth ~ ~iP m - 2(JU3 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 prindpal 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 dedsion-making process on such action, dedsion or recommendation that foreseeably will be heard or reviewed by the dty commission, or a city board or committee. The term specifically indudes the principal as well as any employee engaged in lobbying activities. The tenn "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. ROSEN HAROLD NAME OF LOBBYIST: (Last) (First) 407 LINCOLN ROAD, PENTHOUSE S.E. MIAI BEACH,FLORIDA 33139 (M.!) BUSINESS NAME AND ADDRESS (305) 534-4757 TELEPHONE NUMBER: (Number and Street) (305) 538-5504 FAX NUMBER: (Oty) (State) (Zip Code) EMAlL: I. LOBBYIST RETAINED BY: BEACH TOWING SERVICES NAME OF PRINGPAL/CLIENT: 1349 DADE BLVD., KIAMI BEACH, FLORIDA 33139 BUSINESS NAME AND ADDRESS (305) 534-2128 TELEPHONE NUMBER: (Number and Street) (Oty) (305) 534-6328 FAX NUMBER: (Optional) (State) (Zip Code) EMAlL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)l . NAME OF CHIEF OFFICER, PARTNER, OR BENEFIGARY: JOSE RODRIGUEZ . IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: U. SPECIFIC LOBBY ISSUE: TOWING CONTRACT 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 profdSllfMlolI8YM1onship i : ff1'~';XQ .'~~>3 .,,-- ~ ':_,'.:"J. f 0' <'~ r ~- ,",., '"fl" PARKING Ii. TRANSPORTATION COMMITTEE .,., -, . : ,", , CITY COMKLSSION CITY OF MI,AKI BEA( H PARKING DEPARTMENT CITY OF KIAMI I EACH IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLAT RATE OR OTHER). A) LOBBYIST DISCLOSURE: (Required) $350.00 an hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $350.00 an hour DYes Ili! No: Are vou reoresentina a not-for-orofit corooration or entity without soecial comJensation or reimbursement. Pursuant to Ordinance No. 2004-3435. 1) Pursuant to Ordinance No. 2003-3393 Amendinc Miami Beach City Code Chaoter 2. Article VII. Division 5 Thereof Entitled "Camoaicn Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited Camoaicn Contributions By Lobbyists On Procurement Issues": D Yes ~No: Are vou 10bbvinG on a oresent or Dendina bid for aoods. eauioment or services. or on a oresent or oendina award for Goods. eauioment or service? 2) Pursuant to Ordinance No. 2003-3395 Amendinc Miami Beach City Code Chaoter 2. Article VII Division 5 thereof Entitled "Camoaicn Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited Camoaicn Contributions Bv Lobbvists On Real Estate Develooment Issues": DYes Xl No: Are vou lobbvina on a oendina aoolication for a Develooment Aareement with the City or aoolication for chanae of zonina mao desianation or chanae to the City's Future Land Use Mao? 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 EXPENDITURES .OR Cz==ON DURING T. HE REPORTING PERIOD. /,"'~'7 /~ / -'- ./ Signature of Lobbyist 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 c . In . -482 of the Miami Beach City Code and all reporting requirements. ~.- Signature of LOb~ I) Signature of Principal/Client:LP:o.- ~rl/?~ C::... .-- c- VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: o Produced ID D Produced ID Form of Identification rhersonally known (Lobbyist) Form of Identification ~rsonally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: ,..v PUSt JORGE M RODRIGUEZ <'~o ....... to MY COMMISSION I DD275581 * i< EXPIRES: December 16, 2007 ~~ ~~~ Bonded Thru Budget Notary Servieet "'OFf\.~'- FORCLER~'SUSEONLY ~"""J.4G? /7 /g.JO,e:: Annual Registration fee: [ ] Yes [ ] No Amount Paid ' MCR ~ It..) CJ 1.::) Date Paid q I ( v Lobbyist Registration Form received and verified by: Revised 02/10/04 F: CLER