Robert Switkes/Atlantic Broadb. City of Miami Beach Office or 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 ~he 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' dry personnel defined in any
manner in this section, 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/n lobbying activities. The term "Lobbyists" has specific exclusions, Please refer
to Ordinance 2004-3435.
'NAME OF LOBBYIST:
(Last) (First)
BUSINESS NAME AND-ADDRESS (Number and Street) (City) (State)
'TELEPHONE NUMBER: FAX NUMBER: - EMIL:
(M.I)
(Zip Code)
I.. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CI'IENT: -
BUSINESS NA~E AND ADDRESS' (Number an Street). (Oty)
'~'ELEPHONE NUMBER: FAX NUMBER: (Optional)
(state)
(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:
· IDENTZFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
SPECIFIC LOBBY ISSUE:
~SSue to be lobbied (Describe in detail):
III. crr~ AGENCIES/INDIVIDUALS TO BE LOBBZED:
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER ~iOURI.
FLAT tMT£ OR OTHER, y.
A) LOBBYIST DISCLOSURE: (Required) ~,_~ ~~'C~B
B) PRINCIPAL'S DISCLOSURE (OF LOBBY[ST COMPENSA~ON): (Required).
,
Yes. : Are you representin~ a no,-for-profit corporation or enti~ without special compensation
' reimbursement. Pursuant to Ordinance No. 2004-343~.
1) Pursuant to Ordinance No. 2003-3393' Amendinq Miami Beach Ci~ code Chapter 2, A~icle VII, Division
Thereof Entitled "Campaign Finance Reform" Via The Addition Of Code Se~ion 2-488 Entitled "Prohibite~l
Campaign Contributions By Lobbyi~s On Procurement [ssues"'
Yes D~o: Are you lobbying on a present Of pending bid for goods, eouioment or se~ices, or on a presenl
.or pending award for goods, equipment or se~i~e?
2) pursuant to Ordinance No. 2003-339S Amendinq Hiami Beach Ci~ Code Chapter 2, A~icle
thereof Entitled "Campaign Finance Reform", Via The Addition Of Code Se~ion 2-490 Entitled "Prohibite~l
~moaign Contributions By Lobbyi~s On Real E~ate Development Issues":
Are you Iobbyinq on a pending application for a Development Agreement with the Ci~ or
a0olication for chanqe of zoning map designation or'change to the Ci~'s Future Land Use Mapt
v. S[GNATURE UNDER OATH:
i-lYes ~N0:
ON OCTOBER :!.sT OF EACH YEAR~ EACH LOBBYIST SHALL SUBMIT TO THE CTI'Y CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAM! BEACH. FOR THE PRECEDING CALEND~EAR. A STATEMENT
SHALL BE FILED EVEN IF THERE 'HAVE BEEN NO EXPENDTrURES OR COMPEN ATION DURING THE
REPORTING P.EILI:OD. . . PE~
I do solemnly swear that all of the foregoLqg-~ts are true and correct and that ! have r. ead or am
familiar with the provisions contained,.in"§ectio,n~-482 of the Miami Beach' City Code and all reporting
requirements.
Si, nature of Lobbyist: .~--i~:...~..~"'~ ·
Signature of Principal/Client. ~./~/~/-
,]:. LOBBYIST IDENTIFZCATION: .RTNCZPAL IDENTIFICATZ~ :~.. r~J~'-T'/C.
[] Produced ID
Form of Identification
'~/l~ersonally known (Lobbyist)
Produced ID
Form of Identification
~ersonally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscdbe~ore me
This ~-/ day of~ ,20~C.~(:~
Signature of Public Notary - State of Florida
! ' I
State of Florida, County of Niami-Dade
Sworn and subscribed 'before me
This. -] day of
Sigaature of P_ublicN.o__ta.ry ~State' of Florida
,4a rizatio-~ ~ !,{ i¢~ t u re
I ~ --~:: I l
l
L..;:J~:i';; ...... ~.~.~:.~ 1.
· v//]]y FOR CLERK'S USE ONLY -
Annual Registration fee:.. [ es [ ] No Amount Paid~'~?~-~
Lobbyist Registration Form received and verified by:
Revised 02/:[0/04 F:xC~-ER\ALL\MAR[A-M\LOBBY[S'~LOBBY~ST FORM 04