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Harold Rosen/Cafe Avanti flh>>ml 1l".Q~t1 ~ ~rfP ro 2.CJU5 - 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. . Harold .-Rosen NAME OF LOBBYIST: (Last) (First) Rosen Switkes & Entin ~7)nincoln Road PH BUSINESS NAME AND ADDRESS (Number and Street) (City) (305) 534-4757 TELEPHONE NUMBER: (M.!) SE Miami Beach,~4 33139 (State) (Zip Code) Ff;X. NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Cafe Avanti NAME OF PRINCIPAl/CLIENT: 132 41St Miami Beach FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) TELEPHONE NUMBER: Ff;X. NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (cn · NAME OF CHIEF OFACER, PARTNER, OR BENEFICIARY: Louis Fuentes · IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTL V, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Liquor License Issue to be lobbied (Describe in detail): Ca~ _~"G rlh '-:t 32.. 4 ,'3.+ tA:IQcnl~o.c \\??,R>1 III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship 11"./1......" ~..~ \. > ~, ' . r; , BOA " . . '," IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLA T RA TE OR OTHER); A) LOBBYIST DISCLOSURE: (Required) $7.1:)00 00 $2500.00 1) Pursuant to Ordinance No. 2003-3393 AmendinG Miami Beach City Code Chaoter 2. Article VII. Division 5 Thereof Entitled "CampaiGn Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited CampaiGn Contributions By LobbYists On Procurement Issues"; o Yes lV'No: ui ment or services or on a resent 2) Pursuant to Ordinance No. 2003-3395 AmendinG Miami Beach City Code Chaoter 2. Article VII Division 5 thereof Entitled "CamoaiGn Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited Camoaign Contributions By Lobbyists On Real Estate Develooment Issues"; oYes V. SIGNATURE UNDER OATH: ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THl: PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. / .7 .......~~ / ~~/ .- '/"",?--- Signature of Lobbyist " I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting . ::::~ee:~~ObbYist: ~ Signature of Principal/Client: 13~~Y--'" VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: o Produced ID o Produced ID Form of Identification ~perSOnallY known (Lobbyist) Form of Identification ll"flersonally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade S~orn iOAnd SUbscril(f ,b;fore me ". . Th" U day of ~ .20Q0 \fax 0 u. Chi) Signature Of Public Notary - State of Florida Notarization of Lobbyist's signature .......................................:-1 : LAURA CANO S ~ eomrn.000280111 : ~~ . - ExpII'lII1/'3J2008 f S \{1'onc~~:ff Bondlld lhru (SOOl432..t25Cf . ;;'III/IIIII\'\: FlOrida Notary Assn Inc . I... ...... ........... .... ...... ... ............i State of Florida, County of Miami-Dade Sworn~-!ld SUbscritflefore me Thisl[Ldayof ~ ~ ~D .~ Signature of Public Notary - State of Florida Notarifi'iion.oramR~rJb$i'grrB'hf1!e . ~\\'I"'I"'I : : A~.~y PI/;"" Comm# 000280111 : : ~~ . ~~ ExpIres 1/13/2008 : : =~ ~:: D..._-, . : .....JOFF\.~~ """oued II1ru (800)432~254: i....::::~~:......!~.~otaty Assrl., Inc : .................., . / FOR CLER~'S USE ONLY . . Annual Registration fee: V] Yes [ ] No Amq.unt Paid ..:25~J MeR # .? 8--=t-\ c;:+ Date Paid Lobbyist Registration Form received and verified by: ~ ~ Revised 02/10/04 F: R\ALL\M IA-M\LOBBYIST\LOBBYIST FORM 04 &)Iolef{;;>