Mark Rosenblum/Miami CityBalletMiAMiBEACH
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.
Rosenblum
NAME OF LOBBYIST:
Miami City Ballet, Inc.
BUSINESS NAME AND ADDRESS
305-929-7000, ext. 1500
TELEPHONE NUMBER:
Mark
(Last) (First)
2200 Liberty Avenue, Miami Beach, FL 33139
(Number and Street) (City) (State)
305 - 929 - 7002 markr@miamicitybal let. org
FAX NUMBER: EM~/L:
(M.I)
(Zip Code)
NAME OF
Miami
LOBBYIST RET/k/NED BY:
Miami City Ballet, Inc.
PR/NCIPAL/CLIENT:
City Ballet, Inc. 2200 Liberty Avenue, Miami Beach, FL 33139
BUSINESS NAME AND ADDRESS
305-929-7000, ext. 1500
TELEPHONE NUMBER:
(Number and Street) (City)
305-929-7002
FAX NUMBER: (Optional)
(State)
markr@miamicitybal let.
EMAIL: (Optional)
(Zip Code)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
· NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Pamela N. Gardiner
Executive Director
· IDENIIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: N/A
SPECIFIC LOBBY ISSUE:
Grant application to the City of Miami Beach Cultural Affairs Program Tourism & Cultural Dev.
Issue to be lobbied (Describe in detail): Cultural Anchors
III. ClTY AGENCIES/INDZVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
Miami Beach Cultural Arts Council Members .....
DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
IV.
FLAT RATE OR OTIVER~
o
A) LOBBYIST DISCLOSURE: (Required)
0
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":
[] Yes '~No: Are you Iobb¥inq on a Dr~-,~nt or ~endinQ bid for aoods, e~uiDment or services, or on
pr~_~_~nt or Dendinq award for ooods, e~uiDment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Tssues":
OYes ~No: Are you IobbvinQ on a pendina aD=lication for a D~velopment Aqreement with the City or
· ' application for chanae of zoninq map desiqnation or chanqe to the City's Future Land
Map?,
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definiUon 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..
~Yes [] No: Are you representinq a not-for-profit corporation or entity without special compensation
~ or reimbursement, ·
V. S'rGNATURE UNDER OATH:
· ON OCTOBER 1; OF EACH YEAR, EACH LOBBY/ST SHALL SUBMIT TO THE C/TY 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 EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DUR/NG THE
REPORTING PER/OD.
~ ~ ofLobb~ist
! do solemnly swear that all of the foregoing fac~s are true and correct and that ! have read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VZ. LOBBYIST IDENTIFICATION: PR/NCIPAL IDENTIFICATZON:
[] Produced ID
Form of Identification
~ersonally known (Lobbyist)
[] Produced ID
Form of Identification
~'ersonally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade State of Florida, County of
Sworn to and subscribed before me Sworn and subscribed before
This ~ day of ~ 20~ This ~ay of ~
d
Signature of ~bl~ Nota~- State of Florida Signature of Public Nota~ ] q~' FI~~~~~.~
No~rm~tmon of Prmncmpal s smgna~u~
No~ri~Uon of Lobbyist's si~na~~~
Annual Registration f~: [ ] Y~ [ ] No Amount Paid ~_~~ ~. *~ Date Paid _
Lobbyi~ Registration Fo~ receiv~ and verifi~ by: ~ ~ ~
F:~CLER~$ALL~MAR~-M~Lobbyist~LOBBYI~ ~RM 05.~-' ~ Revis~ 12/08/0~