Kent Robbins/Atlantic Gardens
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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 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 in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer
to Ordinance 2004-3435.
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BUSINESS NAME AND ADDRESS
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TELEPHONE NUMBER:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CUENT:
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BUSINESS NAME AND ADDRESS (Number' and Street) (City)
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(State)
3313 OJ
(Zip Code)
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (e)l
. NAME OF CHIEF OFACER, PARTNER, OR BENEAClARY:
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. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
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III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS 0 LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLATRATEOROTHER): d; 5
A) L~BBYIST DISCLOSURE: (Required) i3 0 V ('
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
o Yes ~ Are YOU representina a not-for-Drofit corDoration or entity without sDecial comDensation or
reimbursement. Pursuant to Ordinance No. 2004-3435.
1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions BY LobbYists On Procurement Issues":
o Yes~. Are YOU lobbyinG on a Dresent or Dendin<<;1 bid for Goods. eGuiDment or services. or on a Dresent
or Dending award for Goods. eGUiDment or service?
2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "Campaign Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Campaian Contributions By LobbYists On Real Estate Develooment Issues":
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE P CEDING CALEN YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO E ITU OR C SATION DURING THE
REPORTING PERIOD.
Signature of Lobbyist:
Signature of Principal/Client:
VI.
true and correct and that I have read or am
f he Miami Beach City Code and all reporting
o Produced ID
PRIN~IDENTIFICATION:
~uced 10 1'11- bL 6dbO <f-7 ( 3 7/fs 7 0
Form of Identification
Form of Identification
~;SOnaIlY known (Lobbyist)
o Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed efore me /
This . t1J. day of 20~
j
State of Florida, County of Miami-Dade
Sworn and subscrib before me
This -LL-day of , 20~
SI nature of Public Notary - t e of Florida
Notarization of Lobbyist's signature
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Annual Registration fee: LV"] Yes [ ] No Amount Pad>
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F: