Willis "Chip" Arndt/Comm AIDS
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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 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 tenn "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
1frnrl+j' willi~ "r.hip" C.
NAME OF LOBBYIST: (Last)
( First)
(M .1)
('()Jl1Jl1llnity AIDS Resource. Inc.. <ilia Care Resource, 3510 Biscayne Boulevard, Miami, FL
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 33137
(101:\) 1:\7fi-l?14
TELEPHONE NUMBER:
(305) 571-2020
FAX NUMBER:
carndt@careresource.org
EMAIL:
I. LOBBYIST RETAINED BY:
C9mml:ilni~ AID9 R~"',",11rf""'':>.
NAME OF PRINCI l./CUENT:
Tn,...
(ll-~ C'flrp Resource
3510 Ri~r.~yne Boulevard, Suite 300. Miami, FL 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
(Zip Code)
(10S) S7fi-l?34
TELEPHONE NUMBER:
(305) 571-2020
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:
II. SPECIFIC LOBBY ISSUE:
Miami Beach Visitor & Convention Authority Tourism Advancement Grant Application
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
Miami Beach Visitor & Convention
i hl Board N/A
)P"\
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) No r.o11'1pPn~i'lt-i on ot-hpr t-hi'ln rpg111 i'lr ~i'l1 i'lry
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required)No compensation.
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
D Yes ~ No: Are YOU lobbvina on a Dresent or oendina bid for aoods. eauiDment or services. or on a
Dresent or Dendina award for aoods. eauiDment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes ~ No: Are YOU lobbyina on a Dendina aDDlication for a DeyeloDment Aareement with the City or
aDDlication for chanae of zonina maD desianation or chanae to the City's Future Land Use
MaD?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of a not-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees..
Yes D No:
Y. SIGNATURE UNDER OATH:
ON OCT08ER 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 COMPENSA ON DURING THE
REPORTING PERIOD.
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. h
Signature of Lobbyist: t"U
Signature of Principal/Client:
VI.
PRINCIPAL IDENTIFICATION:
D Produced 10
D Produced 10
Form of Identification
)2 Personally known (Lobbyist)
SIGNATURE AND STAMP OF NOTARY:
Ol(Personally known (Principal)
'~5tate of Florida, County of Miami-Dade
i:sworn to and subscribed before me
;c. '", ;;ThiS ~~ day of A ti Jsl- . 20 as-
.- ~:1 ~6 t €!::i:2
;--~!i';j ^~ ...
2 .~ iitignatur of Public Notary - State of Florida
'-, 0;;;, Notarization of Lobbyist's signature
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This ~day of A \~,}'5t- . 20 D ~
Vvf4 ~
Signature of Public Notary - State of Florida
Notarization of Principal's signature
/ FOR CLERK'S USE ONLY
Annual Registration fee: [ ] Yes [ V] No Am~aid MCR #
Lobbyist Registration Form received and verified by: lJ. /1' "R..iU'C~
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05. oc
Date Paid
Revised 12/08/04