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Hector Holsman/Oasis Drexel LLC ft1mmi BeiKh ItI:8d U ztltl3 m ~ 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 term "LobbyistsN has specific exclusions. Please refer to Ordinance 2004-3435. lIo~?MVvJ NAME OF LOBBYIST: (Last). l~~1- ~L-~rJ RL ~) BUSINESS NAME AND ADDRESS (Number and Street) (City) 3o~ -l:J-R -LLf (2- ~3T2 -O~O 0 TELEPHONE NUMBER: FAX NUMBER: HtLTV7< ( First) rt(f\K~~ -~~ \ (State) (M.I) t:G6~ \')9 (Zip Code) EMAIL: (jf7-fuA CA~7 Fe tn! ffmA 6CJ-P 531 Ie; (State) (Zip Code) I. LOBBYIST RETAINED BY: NAME OF PRINCIPAl/CLIENT: ~... sS.NA -ME~. ADD~OX(NUmlr~Q2Lf ~~). '30 S Lfe/f 0 / / :;;q TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or trust [Section 2-482 (c)l · 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: HIS71JRiC P(2E~72vftT7D1\J EtJrJRfJ - EXn;-rt01'2 Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (A-ftWbE~ r 132fO To /330 D12fJlt;~ M A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship HI JtTJ(} C Bst~J:r 0 OAj IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATI N (DISCLOSE WHETHER HOURL Y, FLAT RA TE OR OTHER): ~ A) LOBBYIST DISCLOSURE: (Required) .~ B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). 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"; ment or services or on a 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues"; 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 se ion but, shall not be required to pay any registration fees.. V. SIGNATURE UNDER OATH: I do solemnly swear that familiar with the provisions c requirements. Signature of LObbYist~ Signature of Principal/Client: 1/ nd correct and that I have read or am 'ami Beach City Code and all reporting VI. o Produced ID Form of Identification ~nallY known (Lobbyist) o Produced ID ~ Form of Identification ~rsonallY known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: 'S ,~~ ON;1RcI!:-7 9 go l Date Paid Revised 12/08/04