Schwartz, Gerald/Publix Superm.
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MIAMI BEACH
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.
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NAME OF LOBBYIST: (Last) (First) (M.!)
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BUSINESS NAME AWD ADDRESS (Number and Street) (City) (State) (Zip Code)
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TELEPHONE NUMBER:
31;6- ~'1?>" 6506
FAX NUMBER:
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EMAIL:
I. LOBBYIST RETAINED BY:
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
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(Zip Code)
TELEPHONE NUMBER:
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: :r6~ A-# A'T1A-W~t:r-.e.- \
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IDENTIFY AiL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% 'oR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
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II. SPECIFIC LOBBY ISSUE:
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Issue to Be lobbied (Describe in detail): U
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relatio~ip <::)
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) --I BSo.~ ~ ho~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (ReqUired).J 0 So . Oi) ~ ~
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 YeslS..No: Are YOU lobbyinG on a Dresent or !)endinG bid for Goods. eauiDment or selVices. or on a
Dresent or oending award for GOods. eauiDment or selVice?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes ~o: Are you lobbying on a DendinG aDDlication for a DeyeloDment Agreement with the City or
aDDlication for chance of zoning maD desicnation 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-far-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..
D Yes ~o: Are you reDresentina a not-for-Drofit corDOration or entity without sDecial comDensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1 Sf OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSA N
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECED CALENDAR YEAR. A
SHALL BE FILED EVEN IF THERE HAVE BEEN NO OR COM N
REPORTING PERIOD.
Code and all reporting
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State of Florida, County of Mial"; Bade
Sworn and subscribed before me
This j5~ay of :Pece~nber. 20Q)
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Signature of ic Notary - State of Florida
Notarization of Principal's signature
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Form of Identification
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Form of Identification
~SOnallY known (Principal)
SIGNATURE AND STAMP OF NOTARY:
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:V# MY COMMISSION II 00168886
~ 01 ,..~... EXPIRES: December 2. 2006
1-8QO.3.NOTARY FL Notay Servioe & Bonding, Inc:.
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OM'::> Date Paid
ReVised 12/08/04