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Howarth David / IHC MB Corp 11j.;~::.. tl,-,~. ') b::t'td 7iTP lD ~u.:; - -- ? 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, actioo or decision of any commissioner; any action, dedsion, recommendation of the City Hanager or any city board or committee; or any action, decision or recommendation of any dty 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 dty 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. NAME Of LOBBYIST: Howarth (Last) David (first) (MI) v-Jvndham International, 1950 stemrrons Freeway #6001, Dallas, 'IX 75207 BUSINESS NAi'lE AND ADDRESS (Number and Street) (City) (State) (Zip Code) 214-863-1297 TELEPHONE NUi'lBER: 214-863-1262 FAX NUMBER: dhowarth@wyndham.com EMAIL: 1. LOBBYIST RETAINED BY: IHC/Miarri Beach CorpJration NAME Of PRINCIPAl/CLIENT: 1950 StermDns Freeway, Suite 6001, Dallas, Texas 75207 BUSINESS NAi'1E AND ADDRESS (Number and Street) (City) (State) 214-863-1285 (Zip Code) TELEPHONE NUMBER: fAX NUMBER: (OptiOnal) EMAIl: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (cJl NAME OF CHIEF OFFICER, PARTNER, OR BENEHCIARY: IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Challenge -to }X)ss:lble designation of Wyndham .Miami Beach Resort 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 Jorqe Gomez, Director of Planning None -.-- ~ William Cary J Director, Design, PrE servation and Neighborhood Planning Di, , lis ion - rbne 'Ihanas Mxlney, Design and Preservation Manager Historic Preservation Board - rbne Planning .Poard - None City Commission and Staff rbne None IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLA T RA TE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). Salaried employee of Principal Salaried employee of Principal 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": 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": DYes IX No: Are YOU lobbyina on a oendina aoolication for a Develooment Aareement with the City or aDDlication for chanae of zonina maD desianation or chanae to the City's Future Land Use MaD? 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.. o Yes ~ No: Are YOU reDresentina a not-for-Drofit corDoration or entity without sDecial comDensation or reimbursement. 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 COMPENSATION DURING THE REPORTING PERIOD. JJaNJ V .~ Si nature 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 contained in Section 2-482 of the Miami Beach City Code and all reporting requirements. ~ Signature of Lobbyist: . Signature of Principal/Client: .. VI. LOBBYIST IDENTIFICATION: PRINOPAL IDENTIFICATION: [J Produced ID D Produced ID Form of Identification Form of Identification ~SOnaIlY known (Principal) ~ersonallY known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed before me (' flis ,)...."f\\- day of-Ja."u.L'"c'1 ' 20JL5 '--t'~~. . Signature of Public Notary - State of Florida Notarization of Lobbyist's signature 1f(fid~ ~t( ':> State of ., County of Miarni-etlde Sworn and subscribed befhe me C ThIS~~~ Signature of Public Notary - State of Florida Notarization of Principal's signature . /~ FORCLE K'S/USE.,9NMLCYR#/17,/t:74I Annual Registration fee: [ V] Yes [ ] No Amount Paid If'- _ 't' L7 L Date Paid Lobbyist Registration Form received and verified by: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 0 Revised 12}08}04 c /~f.~IfQ (~ ...~~,,<-,,\ :~J.~ ~~ \~,:;,...,.......~~ ~.' _~_ h..".....-p INf- !..ANUMAI\. I.": 0 f)MMI~SION FlIP'''E:;}h ,pro,,,,.). 0