Roberta Kjelgaard/Cindy Brown 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, dedsion, 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 pedod 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 includes the
principal as well as any employee engaged~ri lobbying activities. The term "Lobbyists" has specific exclusions. Please refer
to Ordinance 2004-3435.
(Last) (First) (M.I)
Miami Light Project 3000 Biscayne Boulevard, Suite 100, Miami FL 33137
BUSINE~ NAMEANDADDRE~
305-576-4350
(NumberandS~eet) (Qty)
305-576-6480
(StaR) (Zip~de)
@miamilightproject.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBY[ST RETATNED BY:
Cindy Brown, Managing Director
NAME OF PRINCIPAL/CLIENT:
Miami Light Project
3000 Biscayne Boulevrad, Suite 100, Miami FL 33137
BUSINE~NAMEANDADDRESS
305-576-4350
(NumberandS~eet) (City)
305-576-6480
(StaR) (~pC0de)
cbrown@miamilightproject.com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if prindpal is a Corporation, Partnership or Trust [Section 2-482 (c)]
· NAME OF CHIEF OFFICER, PARTNER, OR BENEFIC/ARY:
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
SPEClrFZC LOBBY ISSUE:
Presentation in support of Miami Project Hip Hop 2006 grant application
Issue to be lobbied (Describe in detail):
CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/TiUe B) Any Financial, Familial or Professional RelaUonship
MBVCA Cultural Tourism Panel
1V. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBY[ST COMPENSA1/ON (DISCLOSE WHETHER dYOURL
FLA T IM TE OR OTHER):.
A) LOBBYIST DISCLOSURE: (Required) ~'~ ~,)
B) PR[NCIPAL'S DISCLOSURF (OF LOBBYIST COMPENSAT[ON): (Required).
Yes [] NO: Are you reuresentina a not-for-orofit corooration or ertl;ltv without soecial compensation or
reimbursement. Pursuant to Ordinance No. 2004-343S.
1) Pursuant to Ordinance No. 2003-3393 Amendinq Miami Beach City code Chapter 2, Arl;icle VII, Division 5
Thereof Entitled ~Camoai0n Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaion Contributions By Lobbyists On Procurement I~$ues":
[] Yes [=~No:
Are you Iobbvina on a present or Dendino bid for aoods, eauiDment or Services. or on a Dresent
or Dendina award for aoods, eauiDment or service?
2)
Pursuant to Ordinance No. 2003-3395 Amendinq Miami Beach City Code Chapter 2, Article VIT Division
thereof Entitled "Camoaion Finan~;e Reform", via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaion Contributions Bv Lobbyists On Real I~state Development Issues":
[]Yes ~ No:
Are you Iobbvina on a ~endina aDDlicaUon for a Development Aareement with the City or
application for chanae of zonina mad desianaUon or chanae to the City's Future Land Use MaD?
SIGNATURE UNDER OATH:
ON OCTOBER IsT OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE ClTY CLERK A SZGNED
STATEMENT UNDER OATH, L~ST/NG LOBBYING EXPENDTrURES, AS WELL AS CONPENSAI'~ON
RECEIVED, ZN THE CITY OF MLa, M! BEACH FOR THE PRECEDZNG CALENDAR YEAR. A STATEMENT
SHALL BE F/LED EVEN ZF THERE HAVE BEEN NO EXPENDTrURES OR COMPENSAT/ON DUR/NG THE
REPORTING PER/OD.
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 Principal/Client:
VZ. LOBBY[ST IDENTZFTCA'I'~ON: ~PR/NCZPAL IDEN1/F[CATION:
Produced ID [] Produced ID
Form of Identification
Form of Identification
X:l Personally known (Lobbyist)
VZZ. STGNATURE AND STAMP OF NOTARY:
Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ~'~"' day of ~-~-'.,~ ,200.~
Signature of Public Notary - State of Flodda
Notarization of Lobbyist's signature
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This [~'~'~'_day of w---,I c~,20o~-
Signature of Public Notary - State of Florida
Notarization of Principal's signature
o.e~ ~% Roberta K Posner .~,-.~'~,,~ Roberta K Pusher
~ ~ ; My Commission DD3~496 [~ ; Y C~m~ss~on DD3~496
*,J~.~ ~xp,,es October 20. 2008 oF~ ~xplms ~o~ 2~ 2~8
./ FOR CLERK'S~E ONLY ~'0~~'~*
Annual Regi~ation fee: [ ] Yes [ ~ No Amount Paid~/d/ MCR ~ .... Date P~
Lobbyist Registra~on Form received and vedfied by: / ~ ~
Revi~d 02/10/04 F: CL~LL~[A-M~LOBBYZS~LOBBY[~ ~RM ~