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Robbins Kent/Sobe USA LLC \:.~'nl H".lft'l m --"~ 'iiii' - ~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, action or decision of any commissioner; any action, decision, recommendation of the Cty Manager or any dty 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 foreseeabiy will be heard or reviewed by the dty commission, or a dty board or committee. The term specifically indudes the principal as well as any employee engaged in lobbying activities. The term "lobbyists- has specific exdusions. Please refer to Ordinance 2004-3435. NAME OF LOBBYIST: ,(o~ 5 (Last) ~t l2Z BUSINESS NAME AND ADDRESS 305 532. 0500 TELEPHONE NUMBER: (First) lYJiM1f 1& C( ber and Street) (Cty) 3b5 'O3l 0(50 FAX NUMBER: \t- (M .I) 351 (State) (Zip) Kh( obb @. ~ ~+il" fl2..,+ EMAlL: I. LOBBYIST RETAINED BY: ~Obe- U~A~ NAME OF PRlNOPAL/WENT: ",': 1 quo OCtaYl D'I vL BUSINESS NAME AND ADDRESS (Number and Street) rn \a r\'\ ~ ~Ctch (Cty) 'Fl- (State) 3~1~ (Zip TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAlL: (Optional) FIll out this section If prlndpal is a Corporation, Partnership or Trust [SectIon 2-482 (e)) . NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: C~~ne... A r (\ 0h\ - M40J It\q ~ ea.....- Yt\:x.a l Coo02ttlt.c) MAAt:\.lilnq ~ . IDENTIFY AlL PERSONS HOLDING, DIRECTlY OR INDIRECTlY, A 5% OR MORE OWNERSHIP INTERESlPIN 6lJCH CORPORATION, PARTNERSHIP OR TRUST: 'Jl (L CA+tr.tC hl.c\ \io i' U. SPEaFIe LOBBY ISSUE: Co'i\Cer" t IU. CITY AGENCIES/INDMDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Flnandal, Familial or ProfessIonal Relationship \-h~)roY;~ ~ft.O~(v'o.hon ~oaro\ N \)l\L- IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLAT RATE OR OTHER): A) lOBBYIST DISCLOSURE: (Required) ~5,600 r'~ I .?J15/~ , I B) PRINaPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). . t;(D-ob ~ t 315 ~ I D Yes l~: Are YOU reDresentlnG a not-for-Droflt corooration or entity without soecial comoensation or reimbursement. Pursuant to Ordinance No. 2004-3435. 1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach Citv Code Chaoter 2. Artide VII. Division 5 Thereof Entitled "Camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited Camoaian Contributions BY Lobbvists On Procurement Issues": D Yes ~o: Are YOU lobbyinG on a Dresent or oendlnG bid for 90ods. eaulDment or services. or on a Dresent or DendinG award for Goods. eauiDment or service? 2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach Citv Code ChaDter 2. Article VII Division 5 thereof Entitled "CamDaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited CamDaign Contributions Bv Lobbvists On Real Estate Development Issues": DYes ~o: Are YOU lobbyinG on a DendinG aDplication for a DeyeloDment AGreement with the City or aDDlication for chanGe of zoninG maD desiGnation or chanGe to the City's Future Land Use MaD? v. SIGNATURE UNDER OATH: ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE arv CLERK A SIGNED STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR R. A STATEMENT SHALL BE FILED EVl!N IF THERE HAVE BEEN Nt.?jZiE Dro/.t. S R CO NS ON DURING THE REPORTING PERIOD. ---i Signature of lobbyist I do solemnly swear that all of e foregoing facts are true and correct and that I have read or am familiar with the provision ont ined in '0 -482 Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/CI VI. LOBBYIST IDENTIFICATION: PRINCPAL IDENTIFICATION: o Produced ID o Produced ID Form of Identification / Personally known (Lobbyist) Form of Identification c1Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed before me 5 This 10 day of ~p Y .20Q. ~~~ Signature of Public Notary - State of Florida Notarization of Lobbyist's signature State of Florida, County of Miami-Dade Sworn '0' subSCribedJf!?~e me This day of ~ 20f!!} e;..e:t;l t:l#1Kv ~ Signature of Public Notary - State of Florida Notarization of Principal's signature t)~ BETH ANN BARASH ~ MY COMMISSION # D0332547 ~ EXPIRES: June 24, 2008 1-800-3-NOTAIlY FI. NOllUy Discount Assoc. Co. Date paidS)I(Jf~5 ill 1 ;( , II .____.w_._..... . 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