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Larry Fontana/AEG Live & ~1t;mmi B~h 2(l1l1l - 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 exelusions. Please refer to Ordinance 2004-3435. Fontana Larry NAME OF LOBBYIST: Nokia Theatre (Last) 101 Performance Place (First) (M.I) Grand Prairie TX 75050 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 972-854-5087 TELEPHONE NUMBER: lfontana@nokiatheatredfw.com FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: AEG Live LLC NAME OF PRINCIPAL/CLIENT: AEG Live LLC 5750 Wilshire Blvd. Suite 501 BUSINESS NAME AND ADDRESS (Number and Street) (City) Los Angeles Ca 90036 (State) (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: IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH g CORPORATION, PARTNERSHIP OR TRUST: u) ; .,--; -n ,.. ." II. SPECIFIC LOBBY ISSUE: .r.- Jackie Gleason Theatre Issue to be lobbied (Describe in detail): v ,_........ ::~: c:> III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: '.~0 l 0-' r",-1 A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship Mayor, City Commissioner N/A And City Staff IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER) B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). Part of regular compensation Part of regular compensation A) LOBBYIST DISCLOSURE: (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 lobbyina on a Dresent or Dendina bid for aoods, eauiDment or services, or on a Dresent or Dendina award for aoods, eauiDment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes [J No: Are YOU lobbyina on a Dendina aDDlication for a DeyeloDment Aareement with the City or aDDlication for chanae of zonina maD desianation 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-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 it No: Are YOU reDresentina a not-for-Drofit corDoration or entity without sDecial comDensation or reimbursement. 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 THE PRECEDI CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITU S OR COMPENSATION DURING THE REPORTING PERIOD. I do solemnly swear that all of th foregoing facts are true and correct and that I have read or am familiar with the provisions contai d in Section 2-482 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: C Produced ID TOL 11 O{j, 7,?1f Form of Identification PRINCIPAL IDENTIFICATION: VI. :: Produced ID VII. i f ARY: Form of Identification i~ersonallY known (Principal) (~:I ;fori1,c, La A"ilS State of ~a, County Of ~1i3mi Dad Sworn and subscr." ed efore me Thisl!1.t!?.-day 2~ - State of ~/ tJJ j ist's signature Signatu uti IC 0 ry ate of Florida Notarization of Principal's signature FOR CLE Annual Registration fee: [ es [ ] No Amount P . Lobbyist Registration Form received and verified by: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05. EONLY~gC~ MC ate Paid Revised 12/08/04