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HomeMy WebLinkAboutAl Brown/Wireless Facilities ~, / City of Miami Beach Office of the 1700 Convention Center Drive, Niami Beach, FL 33139 ' LOBBYIST ~GIST~TION FO~ Lobb~i~ means all ~ns emplo~ or re~in~, whether ~id or not, b~ a p~nd~l who ~ to encourage ~e pa~e, defeat or ~difi~on of an~ ordinance, r~lu~on, a~on or d~ision of an~ ~mmi~ioneu an~ a~, d~isi~, recommenda~on of ~e Ci~ Manager or an~ d~ ~ard or commi~ee; or an~ a~on, dedsion or ~ommenda~on of an~ ci~ ~nnel du~n~ ~e ~me ~~ of ~e entre d~i~on-makin~ p~e~ on such a~on, d~sion or r~ommenda~on ~at fore~eabl~ will ~ heard ~ review~ b~ ~e O~ commi~ion, or a O~ ~ard or commi~ee. ~e te~ s~fi~ll~ indud~ ~e p~ndpal as well as an~ employ~ eng~g~ in Iobb~in9 a~ivi~. ~e ~rm '~b~i~- ha~ ~fic exciuz~on~. ~ea~ refer to O~nance 2~~3~. SS u,um~r ~no ~~) (~) ' (Sm~e) (zip C~e) TELEPHONE NUNBE LOBBYIST RETAINED BY: BUSINESS NAME AND ADDRES--"'~ ~ber~ (City) ~ f_C:~. ,--'" o\ Z ''/ ~ - "' /._ -- (State) (Zip Code) Fill out this section if principal is a Corporation, Partnership or Tru~ [Section 2-482 (c)] · NAME OF CHIEF OFFICER, PARTNER, OR BENEFJ~Ry: '~----.r ~. C.,, J~ ."~ ~. ~ ~ ~, C ~ 0 ZZ. SPECIFIC LOBBY ISSUE: ~Z. CITY AGEN~ES/ZND~DUA~ TO BE LOBBIED: '"~ A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship 1~. DTSCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DXSCLOSE WHETHER HOUR~. Fl..,4 7' RA 7E' OR 0 7'HER~. A) LOBBYIST DXSCLOSURE: (Required) B) PI~NCXPAL'S DXSCLOSURE (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 ]~ssues": 2) Pursuant to Miami Beach City Code 2-490 Entitled rohlbited Campaign Contributions By Lobbyists On Real Estate Development ~[ssues": 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 2-48! 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 o: Are .ou re resenUn a no -for-erorrt cornnraUon or enti'-- witho ' or reimbursement., ut s iai corn nsaUon v. SZGNATURE UNDER OATH: ON OCTOBER IsT OF EACH YEA-- - it, EACH LOBBYIST SHALL SUBMTr TO THE cl'rY CLERK A SZGNED K /r~l: I"K~CI~D]:NG CALENDAR YEAR. A STATEMENT p~pA~)i~T~i~pL~i~.ToE~D.EN ,F THERE HAVE BEEN NO EXPENDTrURES OR COMPENSATION DUR]:NG THE Signature of Lobbyist ! do solemnly swear that all of the foregoing facts are true and correct and that ! have read or am familiar with the provisions contained in Section 2-~t82 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist ~- . Signature of Principal/Clien ON: [] Produced ]:D [] Produced :ID Form of ]:dentification Form of ]:dentification [] Personally known (Principal) VZ! Stal Ju~ ;'2, 2009 State of Florida, County of Miami-Dade This Sworn and subscril~ed before me This ~__day of c,l~~. 20 of Public Notary - State of Florida Signature of Public Notary of Lobbyist's signature NotarizaUon of Principal's signature Annual Registration fee' ~ _ FOR CLERK:S, USE ONLY ......... ' L-- .i '~"b L J ~O Amount Paid _] .~--~(~ ~ MCR ~-~C~'~_Date Lo~Dy~st ~,egistration Form received and verified by: _'~c:x~:~: -" -- # Paid F:\CLER\$ALL\MAR/A_M\Lobbyist\LOBBY]ST fORM 0~ Revised 12/08/0t Califo All-Purpose Acknowledgment F ' State Of Califo.mia County o~ SS. On ~Xc~m~;r~.-,...,/ ¢~ ,00~0,6 before me, personsIly ~ppe~red _~~v,,~ ~ ~ 1~, <~-~'~J,o,~.._..% ~. personally known to me I~ proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that h.e/she/they executed the same in his/her/their autho- rized capacity(les), and that by his/her/their signature(s) on the instrument the person(s), or the en- tity upon behalf of which the person(s) acted, executed the instrument. al. Other Information This information is not required by state law, but is helpful in preventing fi'aud. Type of Ackowledgment: [ZI Individual ;l~Co~orate ~ Partnership ~ Attorney-in-fact ~ Other: Document Identification- umer l~IO: - - Jomal En~ ~:..5 Signer Information ac~ty Cfi corporate): ©2005 Golden State Notary ww~v. GoldenStateNotary. com (888) 263-1977 ATTACHMENT "A" 5% or more ownership interest in Wireless Facilities, Inc. Oak Investment Partners- 7.1% T. Rowe Price- 7.2% Tayebi, Massih - 10.7% Tayebi, Sean- 5.6%