HomeMy WebLinkAboutGoodman Robert S/Manuel E Diaz
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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; or 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 indudes the
principal as well as any employee engaged in lobbying activities. The tenn "Lobbyists" has specific exclusions. Please refer
to Ordinance 2004-3435.
.
NAME OF LOBBYIST:
G ood/nr:l/J .
(Last) ,
~Jxyl
(First)
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(M.!)
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.I :;/)~)1a7~-/242
F NUMBER:
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(State) (Zip Code)
~JnVf)~;[kf~~/>>;lI'},~/Y)
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BUSINESS NAME AND ADDRESS
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LEPHO E NUMBER:
I.
LOBBYIST RETAINED BY: .Q
~uej E, /'/C/ZJr4
NAME OF PRINaPAl/CUENT: )
Fill out this section If principal is a Corporation, Partnership or Trust [Section 2-482 (e))
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFIaARY: /IIcMR'e/ E, .)/d'Z; J.
. IDENTIFY AlL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORA110~ PARTNERSHIP Ol\.TRU~: ). ,
2)yyd ~Z/J//!dl L-U/c?e.JJIaz
II. SPECIFIC LOBBY ISSUE:
~~(~~~_, -kYr ~ ely
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of IndiVidual/Title
B) Any Financial, Familial or Professional Relationship
AI;
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) -;;t~, -5V J--l ~/
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). -$.:z SOO
o Yes 'f..NO: Are YOU reoresentinG a not-for-orofit corooration or entity without soecial comJensation or
reimbursement. Pursuant to Ordinance No. 2004-3435.
1)
~Yes D No:
2)
DYes ~ No:
.
V.
Pursuant to Ordinance No. 2003-3393 Amendinc Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaion Finance Reform" Via The Addition Of Cod~ Section 2-488 Entitled "Pr~hibited
Camoaion Contributions Bv Lobbvists On Procurement Issues";
Are vou lobbvinG on a oresent or oendinG bid for Goods. eGuioment or services. or on a oresent
or oendinG award for Goods. eauioment or service?
Pursuant to Ordinance No. 2003-3395 Amend/no Miami Beach City Code ~haot: 2. Article VII Division 5
thereof Entitled "Camoaion Finance Reform". Via The Addition Of co~e ;ecti n 2-4 0 Entitled "Prohibited
Camoaicn Contributions By LobbYists On Real Estate Develooment Ius":
Are ~ou .lobbyinG on a oendin~ aDolicatio~ for ~ Deyelooment A~:eC~~t ~i~h :'~ C~ :r
aoohcatlon for chanGe of zonInG mao desIGnation or chanGe to t I I ur an U e Mao?
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. 4 A ~ ~ = -- __ _
I v -- / Signatu::Lobb;
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 ction 2-482 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist.
Signature of Principal/Client: ~
VI. LOBBYIST IDENTIFICATION:. ~ ~IPAL IDENTIFICATION:
~ Produced I!X1 "10-777"7 ~r -364 -0 ~ Produced 10 J~M -.5'1J-5 -754&-0
Form of Identification Form of Identification
CI Personally known (Lobbyist)
D Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to arft subscribe~ befor me
This 3 S da f ~ 20.f5.
I
Signature of Public ry
Notarization of Lobbyis
State of Florida, County of Miami-Dade
Sworn aiJP subscribed before me
This -Lday of \-!lAfC ,2005"
!
Signature of Public Notary' t e o~
Notarization of Prindpal's signa
/1J.W,tr~. JWIlLEE J. RODRIGUEZ
f*r~~:"1 MY COMMISSION # DD 061543
~~~,.~ EXPIRES: September 30,2005
'P.I:.fli' i300ded Thru NOla'Y Public Underwriters
,...o:,V';"", JUVILLEE J. RODRIGUEZ
~<r&t1:. MY COMMISSION # DD 061543
ti:~:~~ EXPIRES: September 30, 2005
"1.~iir.;r..~~' Bonded Thru Nola'Y Public UndelWf~ers
Annual Registration fee: [~ Amo t Pai
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F: C~ \AL
-M\LOBBYIST\LOBBYIST FORM 04