Cobalt Construction Serv. LLC
66Jun, 2. 2005:! 4:40P~55385578
..
ROSEN SWITKES ET AL
No. 7605 FP. 4 03/12
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City of Miami Beach Office. of the Oty Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
LobbyIst means an perso~ emcloyed ~ retained, ~r paid or not. ~ . pr\n~a1 who seeks ttJ I!Il1ClO~ tt.. paBSlQ8, dIfe8t
or mocli~on of any ordinance, l'85OlUlIon, don or decision ci any CIOlTYT1i!i51oner; any actiOn, de~gn, r<<cllTIIrleI1dtion of the
Qty ~nager or any dty board or eonvnittee: or any 3dion. tfedslan Dr remmmendatlon of at!'( dty per.;annel defined tI any
mII'1".r In this section, during the time per1ad of the l!l1Un! decJsion-making proc:ess On sud1 adlon, decision or recornrnerdatlOl'l
that foreseeabfy wiD be heard or revlawed by \tie dty comrnJsslon, or a dty board or ccmmlttee. 'The term gpedbflv Includes the
principal as well as any employee engaged," lobbying ad:IYitIes. T~ mnn "'Lobbyllts- hit spec:ific exclllJlan.. I?I......-fer
tD OrdInanca 2DD4-3435. .
i21-'" 11 :r Aoot.,e r
(Last) (FIrst) .
(M.~... "E ~""#o# J>t..
(Number end street) (et',')
(MJ)
NAM! Of LOS!YISf:
~'2.Q.t,,,., S t.. .or4I6"
, BUSINESS NAME AND AOORESS
(State)
(ZIp Code)
TELEPHONe NUMBER:
,
FI<< NUMBER:
EJI1AIl.::
L. LOBBYIS1' RETAINED BY:
C"t14l,..t" . !O""fGl1,t'tCcMt Se.nlJlttllS. LL~
NAM! OF PRINaPAl./Q,IfNTl
/5$' Af~er ~ ~/~/.tt4~/~
BUSINESS NAME AND ADDRESS (Number and saeet). (OM
~/l-7fl'f-fttJC) ~/J - /'J';P-O'Y"7S
TeLEPHONE NUMBER: rAX NUMBER: (Ol)tlonar)
/'f-? .",
(State)
t)1/~
Gap tGde)
EMAfu (OptIonal)
Fill out this section If Jll'lndl* ,. . COrponltlon, P111'tMt1h1p or TJ'UIt [SIctIon 2..0412 (el] .
Q NAMe OF OIISP OPF.Ic:ER. PARTNER, OR BENEFICIARY:
15 IDENTIfY ALL pef&JNS HOlJ)ING, D1~Y OR INDlRECT1.Y, A 5% OR MORE OWNERSHIP INTiREST IN SUCH
CORPORA11ON, PAllTN1:RSH1P Oft 'TRUST: ,
, .
D. IPlClflC LOBBlISSUE:
M6QIF"ICAXt.-G -' . IJ1r~ ..; M't-\+JC Q' 0 fL9~ I
ISSUE! fa be lobbied (DestrIbe In detail): I
:ElL . CITY AGENClESJtNDIVlDUALS TO H LOBBIED:
A) Full N.... or Indlvldulil/11t.:Ia B) Any Rnandal, Famill8l or Profeaional RelatiDnlhlp
2:>OAa-b of? ~!;;7"""fe...vr ,No
.
0SJ un.
2, 2005: 6: 17PI/055385576 ROSEN SWITKES ET AI.. No.7612 (P. 3
N. D!St:LOSURE OP TERMS AND AMOUNTS OF LOBBYISt CD~ENSATIDN (DISCLOSE WH!TH2R.llfJIJRLY;
FlAT ItA.,. DR OTHER): .
B3/B3
...
A) lOBlMST OlSCLOSURI!: (RequIred) ~ D . *,;;,
. ._~NCIPA\.'S OlSCl.OSlJRE (Of L08BYISTCOMPSNS"iION): (RequIred). . ..... ..
o ~:;.~~;' ..~'~ you n!D~~~~'~;~-~:;~~;;'-~.:O-;';~'~~~o~'~.~~-~~;;~ maelal com.knstiq; ~
, reimbursement. Pursuant to Ordinance No. 2D04-3435.
,
1). PUr1Ulnt to Ordinance No. 2003-n93 Armlnt111'l9 Mllml 8~ Cltv t'~ ctl,Dter 2. Artide vn. DMsion 5
ih~~ Entitled "c:amoolgn Finance Reform"'Via The Addition Of ~e ~~ 2-4f18 Entlt.1~ .ProhlbIted
'C:amDBlgn Contrlbutlon~ Bv lllblWsts On pmcurement Issues':
~ YM ~o:
2)
Art YOu Iobbvlna on ~ pt'Ment Ilrr undina bid for l:IltOd.. eauiDment at services. or Oft a p,..ent
01' >>.ndina i!I~rd for ~. equiDf!1eribr n\"ViceI . .
Pursu~t to Ordi~ance No. 2003.331~ ~p1endlno Miami Beach Cit.v CJde O'Iaomr {. Article VI! 0iv1s1Q.D..~
thereof Entlt1ed "Camrmlan F1~:ano!ll R.&form". Vla i1'le Addltlon Of t;pd~ Sedirm 2~90 E~t1ed "Prohibited
C8moolgn ~ntributlon9 Bv_L~blMsts On Real Estate Oev&IoDtnent tau":
Are ~y lobbyi~ on a ~,,5tln9 aaq'icatlen for a DevtiPJlIl!I't Aoreement with the Cit:y or
_"DUCltt.,,, for chant. 0' en I..., maD dMlan_tlon 01' chanae tp the aty'~ F!,d:ure Land Wile Map?
.' .
DVes ~o:
v.
SIGNATURE UNDER OATH:
ON Oc:rOBER 1$1' OF EACH y~ BACH LOBBYIST SHALL SUBMIT TO 11tE cnv a.ERK A SIGNED
STATEM!NT UNDER OATH, lImNG LOBBYING EXPlNDrTURlI, AS WELL AS CDMPENSATION
RECEIVED, IN THE crrv OF MIAMI 8uat, fOR '11t1: PRECEDING CALENDAR VIAl. A STATEMENT
SHALL BE FILED EVEN IF .mERE .HAVE BEEN NO EXPE ES OR m PENSATION DURING THI!
RiPORllNG PERIOD.
~cn
PRINCIPAL IDINTmCATION: . ..
I do solemnly swear that all of the foregoing facts are
familiar with the provisions contained In Section 2.-482
reql,lirements.
Signature of Lobbyist:
51 nature of pl1nc:ipavafent
VI. LOlmst IDINTXFZCA110N:
D Produced ID
o Produced 10
Form of Identification
I' Personally mown (LObbyt~
VlL SIGNATURE AND STAMP OF NOTAR.Y:
State of Florida, CCunty rI MlamI.Oade
Sworn to~d subscribed before me ~c '.
. ~~~ (bill
FI....M~~..a.tapf Florida
o!IE.i1atWI'M ~ . . tLt
: 6~rlY~\ = 1/1312~~ re
: i' ;1 :
: \~ ~! BonOed thru (800)4;l24254:
: ~~"Jer.r;,\\.'''''' Florida Nctar'j Ar:.Bf'... he :
l....... ...... ............ ..~ ~... t.. ill.. '" ...1
..
Form of Identmcatlon
CJ Personally known (PrIncipal)
State of Florldat Coun~ of Mlami-Dade
S~~ S1Jb 'befOre me f..r
Th' I~day 20~
f.
'. . ~ FOR
Anl'lllll Rtg/sltal1on feel" f..-t"'es [ ] No Am I,lnt
Labbylst ReglstratlDll Form l'ECieiYed and Vl!r1fled by:
Revised 02/10/0'4 F:
us ONLY? ]01. l., : d 1...,01 J../'
.- MCR# ~. -, -",~paid ~
AiUA-M\LCBRYrST\lOeBVlST FORM G4