Quinlivan Mark
02/28/2005 14:44
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BERcaw AND RADELL
PAGE 03/04
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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 modiRcation of any ordinance, resolution, action or decision of any commissioner; any actlon/ dedslOl1,
recommendation of the Qty Manager or any city board or committee; or any action, decision or relXlmmendatlon of any
dty personnel deflned in any manner in this section, during the time period of the entire dec:lsion-rnaldng process on sud1
actIon, decision or recommendation that foreseeably will be heard or reviewed by the dty lXlmm1551on, or a dty board or
lXlmmlttee. The term SPedl'ic:ally indudes the principal as well as any employee engaged In lobl:lylng activities. The term
~l.obbvists'" has spedflc exclusions. Please refer to ordinance 2D04~3435.
NAME OF LOBBYIST:
5130 SW 74 Street
BUSINESS NAME AND ADDRESS
(3051663-6611
TELEPHONE NUMBER:
I. LOBBYIST RETAINED BY:
Oulnllvan
(last)
Mark
(First)
(M.!)
(Number and Street)
Miami
(CIty)
flprlda 33143
(State) (Zip Code)
(305) 665-4921
FAX NUMBESt
EMAIL:
JoseDb W. Blount
NAME OF PRINCIPAL/ClIENT:
2535 Lake Avenue. Sunset Island No.2. Miami Beacb
BUSINESS NAME AND ADDRESS (Number and Street) (Otv)
Florida 3314Q
(State) (Zip Code)
lREPHONE NUMBER:
FAX NUMBER: (Optional)
EMAlL: (Optlonal)
Fill out this IIE1ction If prlndpal is a Corporation, ParmElBhlp or Trost [Section 2-482 (e)]
· NAME OF CHIEF OFFICER, PARlNER, OR BENEFICIARY:
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY/ A 5% OR MORE OWNERSHIP INTEREST
IN SUCH CORPORATION, PARlNERSHIP OR TRUST:
,
II. SP~IIiIC LOBBY ISSUE: .',', ,:
varlatle~ttof.R:'atrb:"'. fn-cOnr1eoliiOl'l ~~~9f~-FamilY Residence
Issue to be lobbied (Describe In detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED=
A) Full Name of Individual/Title B) Any Finandal, Famlllal or Professional
Relationship
Board of Adjustment NONE
Oty Staff NONE
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IV. DJSa.OSURE Of tERMS AND AMOUPtlS OF lOBaYlsr COMP~'JlON-(&lSCtOSE Wffm.frR HOURlY,
FLAT RATE OR OTHER):
A)-DISCwsuo~(_1 ~ 15~Jv.. "k
B) PRmcIPAl'S OrSCI.OSURE (OF LOBBYIST COMPENSATION): (Requ red), ----t ( 'S7J1
ty... :::~~~:-';'~~~gr._-. ..:.;..'::.n.~.,
1)
ur t to in. No. ~003-.s393 ~end~ Miag:. ea i r icl Di on
lhereQf Entitled flCa;';;MIC=!efor ~ Via e Ad :iQn.QLCQde Sedion 2.~ EntltlPrl.p~
~jQnContr/hr'~i"""~ . Oil~~
l.t... ==:...;~:..::~::...:.r;-~' _...... ~__.''''.-.
2)
~~No,~~~__... <-""T -. VII """"" ~
....... ~lIe<i "c.m_ F - m" 1ll!lUdd1=:::.:,.;;j;;' '-4~ E"'~
Com""",,, Contn""""", By """""~ On "'1 -.. 0... : ' .
IY.. '" ":'~~:' ~J::.:" ~n.-:::::.-~ -==.:"~~:::~:;.
80DIlOlltton for cbanaa fIIf 10 Inam 'at' "s L U 1>7
V. SrGNATURE UNDER 04Tt'I:
ON OCTOBER 1ST OF UCK YEAR, EACH LOB&YIsr StIAU StIIJMJ:f, T&'FHe-CfTY CLERk A SlGNm
STATEMENT UNDER OATH, USTINC lOBBYING EXPENDITURES, AS WEU AS COMPENSATION RECEIVED,
IN THE CITY OF MIAMI REACH FOR THE PRECEDING CAlENDAR YEAR, A STATEMENT $HAlL BE FIlED
EVEN IF THERE H.\W.KiN-NColEJlPENDJTttftESOR"COMPtNSATrON DURING THI REPORTING PERIOD,
Signatu,e 9f L~ '
I do solemnlv swear that alf of the foregoing facts ar~ trueand.cmrectaml-tfJat 1 have- read or
am familiar with ffje provisions contained in Section 2-482 of the Miami Beach Oty Code and all
reporting requirements..
Signature of lobbyist: _
S;gfllllure of Prlndpal/Cllent: _ /-J;~ t"V 4~
VI, L08BYISnD~NTJFlCA~ PRINCIPAlIDENTIFICAnON:
~
o ProdUCed ID
Form of Identification
,1 Produced If).
U Personally known (LObbyist,
Form of Identification
FersonallY known (Pr'ncipal)
VII. SIGNATURE AN&-SJ'AMp-OF NOnRY:
State of Florida, County of Miami-Dade
Swom to and SUbscribed before me
This day of . 20_
St*ofFlorida; County of Miami-Dade
SWOm and subscri d bell e me ~"""'"
This-' /" _-r#- ',' , 20QS ~mt~yp' ~\ fan,e t ~
/ / . ~~ i~"'''~
. ~11! ~$ ~ /tIlL JJ.__
Slgnat _ e of ublic Notary - State of Flori(Ja"iI';f,f,fh~ J~~
fforar;z - n or Principal's signatllre ~iJ
Signature of Pubric Notary - State of Florida
NotarizatlOlt of LobbJist.'s.sigQtl#e-
FOR-el-atf('Sun-ONtr
Annual Registration fee: [ ) Yes [ J No Amount Paid --!!l:.' & (; MCR, -2- 7 Y 18 i Date-Pald 3.J '+ I (] S
Lobbyist Req/stratlonfumrrecetvediJlld lIerffred by: <.r ,
RevIsed OV10/04 F: CLa\ALl\MARlA-M\lOBBYJST\LOBBYIST FORM D4
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1 First R4I\IIsion _ 05-f7-02
02/28/2005 14:44
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BERcaw AND RADELL
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FlAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) 5 ~ ~ 1:11 L. .
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST' COMPENSA ON): '(ReqUired). ---..i
I Yes III :-=';r;:~~r:~: a no:~r~:e~~~;:a~c: or entltv without sDec:lal CDrnosnsation or
rel'llbaement, Pu,l'!luant to Ot , an 0 -3 .
1)
~:~:~~~::~~~::~'Fl~~~~;'=~T~ad~e :~~;cc:e ~:~~~ 2E=~~h~~:n ~
~:~aiQnDJCon~b~ons Bv Lobbvists On F>rocu;:eme~t~s~e~~:
__Yes I!I :0: ::.~o: ~':: on a Dresent or e~n:ln: bi~or Goods. eoulomeot or services. or on a Dre5ent
or Qendmo aw~rd for ~DOds. eGUIDm ri_ r :!!.-!.Y!--1
2)
~~~lri~t~~~;i;'OR~~;-:::~~~~~~ ~~~~~~e ~~~~~~E::~,,~~:~:r: 5
~~c ~P.al Eat$ltP. De\ielQpment I!t'lue!l'"
Ii!V..1II N;'1[:.:" 10:;'""" 00' "'.':-;. ..-:.~. D:i::''';~O~-:= ~ ='
aDDllcatlon for manGe 0 zonin aD i n tl n or , ~ aD?
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO llfE 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 co PE ATION OURI E REPORTING PERIOD.
I do solemnly swear that all of the foregoing are true and correct and that I have read or
am faml/[ar with the provisions contained in Section 2-482 of the Miami Beach City Code and all
reportlng requirements,
Signature of Lobbyist:
J~~
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
o Produced 10
CJProducadIO
Form of Identification
Form of Identification
{?personally known (lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
n Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This -r..7 day of J..-Iav(' ~ ,20..Q5
. // ~ I ---
~a.L"'L/./A- ~.. _or--... ~
S'gnature of Public Notary - State of Rorida
NotDl'ization of Lobbyist's signature
State of Florldar County of Miami-Dade
Swam and subscribed before me
This _day of , 20_
Signature of Public Notary - State of Aorida
Notarization of Principal's signature
FOR CLERK'S USE ONLY
Annual RegIstration fee: [ ] Yes [ ] No Amount PaId MCR # Dare Paid
l.obbylst Registration Form reeeived and verified by:
Revised 02/10/04 F: CLER\ALL\MARIA-M\lOBBYIS1'\lOBBYIST FORM 04
1 First Revision _ 05-17-02
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