Kent Harrison Robbins/Sierra Club
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MIAMI BEACH
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 spedfically includes the principal as well as any employee engaged
in I YI activO 'es. The tenn "Lobbyists" has SPecifi~ e}c1USions. Please refer to Ordinance 2004-3435.
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(Last First) (M.!)
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(Zip Code)
EMAIL:
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.C:"BBVlST RET~Ef"l J\J1 L P'
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(Number and Street) (City)
NAME OF PRlNCIPAL/~T:
BUSINES;d ~ND ADD~: t
(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 CHI~F OfFfER, PARTNER, '1JBE~E~CIARY: P '( ( ,. I
~J- Hair (~ "othfAS, I 41" 1(;., '--~( "~.ra.
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
.
II.
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III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/TItle
B) Any Financial, Familial or Professional Relation~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
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A) LOBBYIST DISCLOSURE: (Required)
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":
DYes r on a
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Es e Development Issues":
DYes
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..
nsation
V. SIGNATURE UNDER OATH:
PRINCIPAL IDENTIFICATION:
I do solemnly swear that all of t
familiar with the provisio ct'
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI.
o Produced ID
[] Produced ID
Form of Identification
[~naIlY known (Lobbyist)
Form of Identification
~IIY known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn fs~ subscr,'
This day /'. "~~
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State of Florida, County of Miami-Dade
SworQjl!1CVsubscrib befJ re me mf
This ~9ay of , 2~
FOR CLERK'S~.:9NL Y . ~
Annual Registration fee: [ Yes [ ] No Amount a'- MCR #p}- 7 ~-S
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.
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