Stanley Price/Maria Pellerin
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
** AMENDED**
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.
NAME OF LOBBYIST:
(Last)
Stanlev
(First)
B
(M.I)
Price
Bilzin Sumbera Baena Price & Axelrod LLP 200 S. Biscavne Blvd. Suite 2500 Miami. Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
Zip Code)
305-350-2374
TELEPHONE NUMBER:
305-351-2204
FAX NUMBER:
sorice@bilzin.com
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EMAIL:
I. LOBBYIST RETAINED BY:
Maria Pellerin Barcus. President & CEO
NAME OF PRINCIPAUCLlENT:
Carrfour Suooortive Housina. 155 South Miami Avenue
BUSINESS NAME AND ADDRESS (Number and Street)
(305) 371-8300
TELEPHONE NUMBER: FAX NUMBER: (Optional)
Miami
(City)
FL
(State)
33131
(Zip Code)
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:
Land Use aoolications oertainina to Hardina Villaae. Hardina Avenue & 86th Street. Miami Beach
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of IndividuallTitle B) Any Financial, Familial or Professional Relationship
Planning Board, Victor Diaz, Chairman, and other
members; City Attomey, Murray Dubin, Assistant, None
City Attorney; Gary Held and staff; Planning
Director, Jorge G. Gomez and staff; Zoning Board
of Adjustment, Jason Loeb, Chairman, and other
members; City Manager, Jorge Gonzalez and staff;
Mayor David Dermer and City Commissionsers
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER)
A) LOBBYIST DISCLOSURE: (Required) $500 oer hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
$500 oer hour
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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":
DYes B/ No: Are you lobbying on a present or pending bid for Goods, equipment or services, or on a present or
pending award for goods, equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
o Yes ~No: Are you lobbying on a pending application for a Development Agreement with the City or application for
ihange of zoning man designation or change to the City's Future Land Use Map?
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..
DYes -rA No: Are you representing a not-for-profit corporation or entity without special compensation or
re"f'mbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 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 EV THERE HAVE BEEN NO
EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD.
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Signature of Lobbyist:
t and that I have read or am familiar with the provisions
ing requirements.
I do solemnly swear that all of the foregoing facts are true and c
contained in Section 2-482 of the Mia. ch City Co re
~pr 10
Form of Identification
Personally known (Lobbyist)
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PRI~IPAL IDENTIFICATION:
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Form of Identification
o Personally known (Principal)
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Swon"! _a[W subscri befor me r
his J.O!..'day Of~~W~2~_ ~
Si nature of Public Notary - State of Florida
Notarization of Principal's signature
Annual Registration fee:rf Yes [ ] No
Lobbyist Re i
F:\CLE
FOR CLERK'S USE ONLY
Amount Paid ~'MCR # Date Paid \1) 10J
tied by:
FORM 05.doc Mepr2.~l\1-U
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II'
. 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~: Are you lobbying on a present or pending bid for Goods, equipment or services, or on a present or
pending award for goods, equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
Oevek>pment Issues":
,/
o Yes ~o: Are you lobbying on a pending application for a Development Agreement with the City or application for
change of zoning map designation or change to the City's Future Land Use Map?
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..
DYes p/'No: Are you representing a not-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 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 VEN IF THERE HAVE BEEN NO
EXPENDITURES OR COMPENSATION DURING THE REPO~~ERIO .
. 1 ~ \ ~
Signature of byist
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 o~ Miami Be~ch' e and all reporting requirements.
Signature of Lobbyist: '6
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
Signature of Principal/Client:
o Produced 10
~ Form of Identification
~ Personally known (Lobbyist)
o Produced 10
Form of Identification
~ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
ry t
on of Lobbyist's signature
Annual Registration fee: [] Yes [ ] No
Lobbyist Registration Form re i
F:\CLE
FOR CLERK'S USE ONLY
Amount Paid MCR # Date Paid
.tied by:
FORM OS.doc
Revised 12/08/04
HOLLIB R. HARDISON
f!!1t MY OOMMISSION # DD083444
'+.u\.4' EXPlfUlB: Janulry 10.2006
1-<<JO.3.NOTAAY. PI. NaIIiy tervloe & ~ lie.