Robert Goodman/J. Handy
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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 term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. .
G<<dmiVJ I Af;krt- s:
NAME OF LOBBYIST: ' (Last) (First) (M.!)
Garb" Gtxdm:vJJ //JC!.. .gOI 4'/~.s~,Ja:t~.~~~ FL
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)' (Zip Code) ~.$/.J,lO
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~LEPHONENUMBER: F UMBER: EMAlL: -~ ~~
I. LOBBYIST RETAINED BY:
NAME O;-;lN~
~~~
, M /i?/~F
( ip Code)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
· NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
J~
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
e~o/) 0;- ~a;t/~~
~..Q\C)S
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
e;y amm;s.9~r)
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURl ~
FlATRATEOROTHERt. If
A) LOBBYIST DISCLOSURE: (Required) ~~t't't> O?/?,-?uQ2'/ e
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ~..s;e1GJt!) cil?//?Uoz/ e
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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";
o Yes ~fl; Are you lobbYina on il Dresent or oendina bid for 9O!!dS. equipment Qr s!:rvi~. or on a
Dresent or Dendina award for Goods. eGuiDment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues";
QYes ~o: Are ~ou .lobbYing Qn a pendin~ aDDJica~o~ for ~, DeY!lIODmen~ A~~~n: JlYi~ ~he C;ity ~r
aDDhcatlon for chanae of zonlna maD deSIGnation or chan~e _0 _he_I_'_Fu ur _ Land ~Le
Mul
.. , . ~ . ", .0 ' . > k
3) Pursuant to Miami Beach City Code 2-484 (h)' Any person (except those exe'mpt 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 compen~tion 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..
o Yes )(NC," Are YOU reDl'!l8:nting a not-for-p~fit corooration flr entity witbout sDecial comoensation
' or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBERl5T OF EACH YEAR, EACH LOBBYIST SHALL SUBMn TO THE CITY'CLERI( A SIGNED
STATEMENT U DER. OATH~., LI5nNGLOBBYING EXPENDnURES, AS 'WELL AS COMPENSATION
RECEIVED, I HE CITY OF MIAMI EACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE F ED E~E.N IF THERE AVE BEEN NO PENDITURES 0 COMPENSATION DURING THE
PORn .
I do so emnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisions c ntained in Section 2-482 of the Miami Beach City Code ,and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
f) Produced IDFL )),.,.~S l.ia?nse
JJI.~'!:I~r Form of Identification
-u~'177-S1~4-()
i -] Personally known (Lobbyist)
PRINCIPAL IDENTIFICATION:
II Produced ID
Form of Identification
U Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This I tJ ~ da f {P
State of Florida, County of Miami-Dade
Sworn and subscribed before'me
s _day of , 20_
. nature of Public Notary - State of Florida
Notarization of Principal's signature
FOR CLE~~'S U~ ONLY.. ,,.a , _ ,
Annual Registration fee: ] Yes [ ] No Amoun~Paid ..::dI!:>. MCR # 2=Jce v '_Date Paid \6/ l616s
Lobbyist Registration Form received and verified by: ----k!l ~- t I
.... F:\CLER\$ALL\MARIA-M\Lobbyi5t\LOBBYIST fORM o~ l -- Revised 12/08/04
....
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IV. DISCLOSURe OF -raMS AND AMOUNTS OF \.098YIST COMPENSAnON (DISCl-DSe: WHETH~ HDURL r,
FlAT IrA '11! OR OTIIER.);.
A) lOBBYIST DiSCLOSURE: (Requlrtd) ..$.5: 61/J/74'07.
H) Pll!NClPAI. 'S Clsa.oSURE (Of loaa'l'tST COMP9'15ATlOl'I): (Required). $..i'" tZl
The ,oIlawing Information must bl! answered:
1) Pul'Sllllnt to Miami Beach Otv Code Section 2-48& EnlitlEld "PrchlbitecI campaign Contributions It( LObbylst5
on Procurement ISlaJe$-:
1:1.1"" ~8.g; ::..W: ~=~~n~t::a':::I':!: .:.~:;ipm_ or servil:r5, or pn il
2) Pu!'Sllllnt III Miami eeach Olf Old!! 2-490Entit\ed "Prahlbited Campaign ConbibUllOns By lobbYists On Ileal
Estate Development Issues":
gy. ,*". :~::'t;.:.:::e~":'n:D::,~~";"==':L ,,~:: ~:"u:
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]) PUl'!IIIllnt III MiamI Bead1 CitY Cllde 2""18~ (h) MY ps5DI1 (except those I!lCBl'IIpt fram till!! deflnilian d
"lobbyist" as set ferth in Section 2~81 above) who only .ppears as a rapresentatlve of a not-fDr-Proflt
corporation or entity without spedal compensation, or reimbursement for the appearance, whether tfnct, Clf
Indfredw to express support of or oppolltion tc I"V Item, Shalf register wlth the cierI< as required bV th(s
sectign bUt, shall not be required to PBY any reglstratlon feeS..
P y"", 'tJ No: ~= ::=na II n~lI~ c:D/1lOralitlll Dr entitlr wltho\lt ~lll CDftIMIlgaJ,j1lJl
1'- gr relm~u~me"t. ·
v. SIGN."NRE UNDER OA11I:
ON ocroSER 1 sr OF EACH YEAR, EACH LOBBYIST SHAIJ. SUBMIT 10 THE cnv CLERK A SIGNED
STATEMENT UNDER OATH, U5nNG LOBBYING EXPENDITURES, AS WELL AS COMPENSAnON
RECEIVED, IN THE em OF MIAMI BEACH FOR THE PREceDING CALeNDAR VEAR. A srATEMENT
SHALL 'I! FtLEO EVEN If' THERE HAVE IISN NO EXPENDITURES OR COMPENSATION DURING THE
REpORl1NG peRIOD. /1fd / f /
4V~ ~ --
Signature of Lobaytst
1 do solemnly swear that all of the fOregoIng facts are true and correct and that I have read or am
famUlar with the proviSiOns contained in sectfon~-4S of the Miami Beach City Code and all reporting
requirements.
Signature of lobbyist: .
')(srgnature of I>rindpal/Cltent: ..
VI. LOBBYIST IDENTI1=I
;\'PIlI,.CIPAL IDENTtFICAT!ON~
, ~UCedlD f}.g 01/ 3D~
form of IdentffiatiCln
t I Produced ID
~ IJ Form of Ident1~~tion
~~5.~- 777 ~-J''+-O
1'1 Person'afiv mown (Lobbyist)
\111..
S%GNATUIlE AND STAMP OF NOTARY:
IJ penonal1v known (Principal) COMMONW~,~~ ~~l~~ ;:;~NS~1.. V,I"<
GARY BAUM, Notary Public
City of Philadelphia. Phlla. Coun!y
My Commission Expires November 15, :
Signature of Public 'Notary - State 01' Rcrida
Nal:ilrizalion of LObbylst'~ clgniltura
crary - State ofJilcN:i8a ~,...
ndpal's signature
Stale of Flortcls, CounlV of Mia ml..Dade
Swam to and subscribed before me
This day of ~ 20_
. FOR C1.ERX'S USE aP4l Y
Annua1It.eg1StratiOI1 fee: [ 1 Yes [ J No AmoLlnt Pard MCR ,
LObbyist Registration Form recelvecl ar1d verified I:lV~
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Date PAId
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