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Eric Martinez ... "~llmIBt;l\Jetl " PEr:FI\/FD' . \ _ ~ ~~-... It _ m 05 .JlJ~J 2 -J PH 3: I 4 City of MianlllBtfucliF@ffice 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, derision, 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 includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. ADLER NAME OF LOBBYIST: BRIAN S. (Last) (First) (M.I.) Bilzin Sumberg Baena Price & Axelrod LLP. 200 So. Biscavne Blvd.. Suite 2500. Miami. Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-350-2351 TELEPHONE NUMBER: 305-351-2206 FAX NUMBER: badler(al,bilzin.com EMAIL: I. LOBBYIST RETAINED BY: ERIC MARTINEZ. NAME OF PRINCIP ALlCLIENT: 1330 Bav Drive BUSINESS NAME AND ADDRESS Miami Beach (Number and Street) FL (City) 33141 (State) (Zip Code) 305-825-9090 TELEPHONE NUMBER: (305) 825-9440 FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: SPECIFIC LOBBY ISSUE: 1'63 () [3.C\'-1 Dr. A earin before the Plannin Board -(1 ur C. C> r\. d 1'+: Cnl.l J (.of S ~ C\ Issue to be lobbied (Describe in detail): II. "'0 .; a: , , III. CITY AGENCIESIINDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Anv Financial, Familial or Professional Relationship Planning Board NONE Planning and Zoning Board NONE MIAMI 901940.1 7601521440 '. IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLA T RATE OR OTHER): A) B) LOBBYIST DISCLOSURE: (Required) $360/per hour PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $360/per hour Yes No: X Are you representine: a not-for-profit corporation or entity without special compensation or reimbursement. Pursuant to Ordinance No. 2004-3435. 1) Pursuant to Ordinance No. 2003-3393 Amending Miami Beach City Code Chapter 2. Article VII. Division 5 Thereof Entitled "Campaign Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": Yes No: X Are you lobbvine: on a present or pendine: bid for e:oods, eQuipment or services, or on a present or pendine: award for e:oods, eQuipment or service? 2) Pursuant to Ordinance No. 2003-3395 Amending Miami Beach City Code Chapter 2. Article VII Division 5 thereof Entitled "Campaign Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": Yes No: X Are you lobbyine: on a pendine: application for a Development Ae:reement with the City or application for chane:e of zonine: map desie:nation or chane:e to the City's Future Land Use Map? V. SIGNATURE UNDER OATH: ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK 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. ~ ~. 1/' Signature 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 Secti~2- 82.. f the Mia i each City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: D ,Produced ID / Form of Identification ~ Personally known (Lobbyist) D Produced ID Form of Identification D Personally known (Principal) State of Florida, County of Miami-Dade Sworn to and subs~bed before me _ This ~ day of <- , 20 05 State of Florida, County of Miami-Dade Sworn and subscribed before me This _ day of ,20_ Sig ature of Public Notary - State of Florida Notarization of Lobb ist's si ....."". MERCEDES PADRON /~l:irM~~\ MY COMMISSION # 0, 0,50800 ~*: ::! EXPIRES: November 9, 2006 ~ .....F.'h Bonded ThlU Plcllllld Insu,."ce,t,gency ~,Rfll~'''- .-...=::-.. .-t \ 2S .<J-' \}A.C~ ;2-==t'T35 (Q FOR CLERK'S U~NL Y _ AnnuatReglstratlOn fee:)(Yes [] No A~ount Paid .25 MCR #~SDate Paid (oI2t~ Lobbyist Registration Form received and verified ~ ~~ t)~ " I Revised 02/10/04 ' F: CLER\ALL . A-M\LOBBYIST\LOBBYIST FORM 04 Signature of Public Notary - State of Florida Notarization of Princi ai's si nature ~ w lD ~ 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 Of retained. whether paid or not, by a principal who seel.;s to e"~ourage the passage, defeat or modification of any ordinance, resolution, action or decision of :my eommi$sioner; lIllY action, derision, rccomml;tldarion of th: City MlInager or any city board or committee; Or;my action, decision or reccmmendation of any city personnel defirlcd in any manner in this section, during the time period ofv.e entire decision-making process on such action, decision or recon'\mcndation that foreseeably will be heard or reviewed by the city commission, or a city board or committee. The term specifieally inclUdes the: pr.nciplll as well as any employee engaged in lobbying activities. The term "LObbyists" has Spc.eific exclusions. Please refer to Ordinance 2004-3435. A.DLER NAII'IE OF LOBBYIST: BRIAN s. (last) (First) (M.I.) Bilzin Swnberg Baena Price & Axelrod LtP. 200 So. Biscavne Blvd,. Suite 2500. Miami, Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-350-2351 TELEPHONE NUMBER: I. LOBBYIST RETAINED BY: 305-351-2206 FAX NUMBER; badlerlWbiIzin ,COm EMAlL: ERIC M~RTINEZ. NAME OF PRINCIP ALlCUENT: 1330 Bay Drive BUSINESS NAME AND ADDRESS Mia."i Beach (Numbcr and Street) FL' (City) 33141 (State) (Zip Code) 305.825-9090 TELEPHONE NUMBER: (305) 825-9440 FAX 1\"UMBER; (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partner-sbip or Trust {Section 2-482 (c)l NAME OF CHIEF OFFICER, PARmER, OR BENEFICIARY: IDENTIFY ALL PERSONS HOLDING. DlRECTL Y OR I1\'DIRECTL Y, A 5% OR MORE OVVNERSHrP INTEREST IN' SUCH CORPORATION, PARTNERSHIP OR TRUST: " II. SPECIFIC LOBBY ISSUE: AnDearin't before the PlanniD~ Board Issue to be lobbied (Describe in detail): " Ill. CITY AGENCIESIINDIV!DUALS TO BE LOBBIED: . An Financial, Familial or Professional Rclation,hi , MIA1"H 901940.17601521440 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) B) LOBBYIST DISCLOSURE: (Required) S360fpcr hour Ye!l PRINCIP At'S DISCLOSURE (OF LOBBYIST COlVlPENSA TION): (Required). $350/Dcr hour Yes or 1) 2) Yes a City or v, SIGNATURE UNDER OATH: ON OCTOBER 1ST OF EACH YEAR, EACH LOBB'rlST SHALL SUBMIT TO THE CITY CLERK SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATlON RECEIVED, :m THE CITY OF MlA.J.\1I BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO E.,"{PENDlTURES OR COMPENSATION DURING THE REPORTING PERIOD. C~ ~'~ S~gnature of Lobbyist I do solemnly swear that all of the foregoing facts are true and COrrect llIld that I have read Or am familiar with the provisions contained in Section - fthe Mis. '- each City COde and all reporting requirements, Signature ofLobbyisf: o Produced ID / Fonn ofIdentification ~ Personally known (Lobbyist) vAl. -/ b Clf lDJi;NTlFICATION: Produced ID D"'I'J~ L\c..-<.......;~ Fonn of Identification Signature of Principal/Client: VI. LOBBYIST IDENTIFICA TION: aI Personally known (Principal) ty of Miami-Dade '0 before me UNE ,2005 l ! State ofFJorida, County ofMianu-Dade Sworn to and subs~bed before me nu,~ day of ~' 20 <5' S~li' Noluy - S"'le of Florid. Notllrization of Lobbvist's si MERCEDES PADRON MY COMMISSION II DO 150800 EXPlRES~ Novilll1b8l'9. 2006 l\(lnOtIIlhN_ma.IW1OI ~ a Expies Jen 4. 2009 ~'DD383&05 Banded Br NdonaJ NocIIJ AIM. FOR CLERK'S USE ONLY Annual Registration fee:: [ J Ycs rJ No Amount Paid MCR # Date Paid Lobbyist Regisrration Form received and verified by: Revised 02/10/04 F: CLER\ALL\MARIA-M\LOBBYIST\LOBBYIST FORM 04