Harold Rosen/Fairfax Hotel Partnership Ltd.
11/313/213136 17:213
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ROSEN SWITKES ET AL
PAGE 132/133
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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 prlnclpar who seeks to encourage the passage, defeat
or modlflcatlon of 8ny ordinance, resolution, action or decision of any commissIoner; any action, dedslon, recommendatIon of the
CIty Man8\ler or any CIty board Dr commIttee; or any action, decision or recommendation of any dty personnel defined In any
manner In this section. during the time periOd of the entire deCislon-mal<lng process on such aaion, decision or reCOmmendation
that foreseeably will be heard or reviewed by the city CX)mmlsslon, or a dty board or CDmmlttee. 1lle term spedflc:ally Includes the
princIpal as well as any employee t!ngrlped in lobbying activities. Tne tenn "Lobbyist.!;" has spedtlc exclusions. Please refer
to Ordinllnce 2004-3435.
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NAtY\E OF l.OBBYIStr:
(,j
I!Yiro //
(First)
&(J P~F
(Oty)
~",.. ;~'t.-;5t
FAX NUMBER:
(Last)
(M .I)
Mi~...,'
(State)
hI""
~05 5 J t:.{- t.r? ")
TELEPHONE NUMBER;
. I., LOBBYIST RETAIN.ED BY:
F"a;rf ~'It .J.&, kJ Vcv.f.-'Vr or" ,~
NAMe OF PRINaPAL,lCU~NT: /
;r 1:. (.
aUSINESS NAME AND ADDRESS
J 2.).2~ 1- ~ If
TELEPHONE NUMBER:
ClJ.
I~~' ~C'l
(State)
FL 55/31
(Zip Code)
FAX NUMBER: (OPtional)
. EMAIL: (Optional)
Fill out tnls section If principal Is il Corpora~on, Partnership or Trust [Section 2-432 (e))
· NAME OF CHIEF OFFICER, PARTNER., OR BENEFICIARY:
IDENTIFY All. PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP I~REST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: .
II. SPECIFIC LOBBY ISSUE:
V 0.. t:(!
Issue to be lobbIed (Describe In detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
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A
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A) Full NaMe or Individual/Title ."
B) Any Financial, Familial or Profeuiorlal Relationshli?
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11/30/200G 17:20
3055385578
ROSEN SWITKES ET AL
PAGE 03/03
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IV. DISCLOSURE OF TER.MS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER. HOllRL Y,
FLA r RA TE OR OTHER):
A) LOBBYIST DISCL.OSURE: (Required) .1 5/ coo. (>0 i((;,fltl~
H ,... ~<.'
B) PRlNOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (R.equlred). ..p ~I 000, ?'~"''''flN'f:?I1..
o Yes ~O~ Are vou rl!Dre!lentina a not.for-Droflt cornor8tioo or entity without sDecial comdensatiO.D o.r
reimbursement. Pursuant to Ordinance No. 2D04-3435.
..
1)
~ursuant to Ordinance No. 2003-3393 Amendinq Miami Beac:h City Code ChaDtcL2. Article vn. Division S
Thereof Entitled "Camoaign Finance Reform" Via The Addll:ton Of Code Section 2-488 Entitled "Prohlblteq
CamoalQn Contributions By Lobbyists On Procurement Issu~~
e ou lob . on a r bid ods
Dr Dendlno l!IYnlrd for 90od.5. eaulDtnent or service(
2) Pursuantto Ordi~.lnc:e No, 2003-3395 Amending Miami Beach City Code Cnaoter 2. Article VII Division 5
thereof Entitled "caml{~lc[) Finance Reform", Via The Addition Of Code S~ctJon 2-490 Emitted "~rohlblted
Camoaicn Contributions Bv Lobbvlsts On' Real Estate Develooment Issues":
t or servi
V. 5IGI\IATURE UNDER OATH:
ON OCTOBER 1 In' OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LIS"TING LOBBYING EXPENDrTURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH. FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE 'HAVE BEEN NO EXPENDITURES OR. C' SAll0N (.JURING TI:lE------
REPORnNG PERIOD.
I do solemnly swear that all of the foregoing cts are true and correct and that I have read or am
familiar with the provisions con . ed- ;S-e' n 2-482 of the Miami 8each-CityCode and all reporting
requirements, ~.
Signature of La. YI .
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
PR.INCIPAL IDENTIFICAnoN:' .
D Produced 10
." . Form of Identification
~rSOnallY known (LObbVi~t)
VII. SIGNATURE AND STAMP OF NOTARY:
o Produced 10
Form of Identification
ksonallY known (Principal)
State of Florida, County of Miami-Dade
Sworn ~a"d SUbSCrl~ore me . .
.~ daYOf~ - r 20.Q.0
~CJ19\
Signature of Public Notary - State of Florida
Notar'%atio~.LR.bbvist'5'9Igl\C'ture
, !..............LAURA CA!"J :
i ..,\\\1141'''",,,,, Comm# DClC280111 :
: ff?Ji1~Y P(o~~ Expires 1/13/2CC3 :
: ~t", . ;~ Bonded thru (aC0)432-425ol:
5 \:~Off\.~,:-': .' I Assn:. Inc :
: lGo"'"t1al'" F~.~~.............
.....................
~~\:f ~I~' il:\~~~~l~.o~:~~d: l (.Q~
Sworn and subscribed before me
This ~ day of ~ 200\.0
Signat
Notari ation of
J
NOTARY PUalC. STATE OF LLIQ8
IIr ~81ON IXMES:OlI41nO
. / FOR CLERK'S ~ ONLY .
Annual Registration fee:.. {v1 Yes [ J No Amount PaId ?S"- MeR I/. ~\ c; Date PaId
Lobbyist Registration Form received and verified by: it" t:'9 I
Revised 02{10/0'l F: a \ALL\MARIA'M\LOBBYIsT\LOBBYIST FORM 04
n.JejoCp
0rctcrect \2/g;/6Lp.