Sanford Horwitz/MB Chamber of Commerce
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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 prindpal 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
aty Manager or any dty board or committee; or any action, decision or recommendation of any dty personnel during the time
period of the entire cledsion-making process on such action, dedsion or recommendation that foreseeably will be heard or reviewed
by the dty commission, or a dty board or committee. The term specifically indudes the principal as well as any employee engaged
in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
H 0 r w; t 2- j San fu r-d
NAME OF LOBBYIST: (Last) (First)
5PLH<4-Qo I~I \={)nceDelJ?Dn Ivd~(CDCorol o.b/esA.:3.
BUSINESS NAME AND ADDRESS (Number and Street) (Dty) State) {Zip Code) ) 313
305 - L-/ L-j d. d;;)OO 305- t-lL/ L/ ~ 0&80
FAX NUMBER:
(M.!)
TELEPHONE NUMBER:
~"dy. hon...v;tz eDCI'Sp Ih. Co
EMAIL: J
I. LOBBYIST RETAINED BY:
.f'A 10 ('f) i eeo c h
NAME OF PRINOPAljCUENT:
\Cl;;;10 me r (. d i (;, n A v-e
BUSINESS NAME AND ADDRESS (Number and Street)
C h 0 n', 'c:e>r o.{' Co (Y) (Y\e,v c.-e..
13E:tAc \., I F L 2> 3 I 2> g
(State) (Zip Code) .
M letrv"'l;
(City)
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 OFFICER, PARTNER, OR BENEAQARY:
IDENTIFY ALL PERSONS HOLDING. DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
n.
SPECIFIC LOBBY ISSUE: Ad
lCUvt'SW1 vu..w.uwtut
Issue to be lobbied (Describe in detail):
(')()~~J
m. CnY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/T1t1e B) Any Financial, Familial or Professional Relationship
,; . " I I . J
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHE11IER HOURLY,
FLA TRATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
o
B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
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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":
n Yes rZ Are YOU lobbvinG on a Dresent or [)endino bid for Goods. eauioment or services. or on a
oresent or oendina award for GOods. eauioment Dr service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Zte Development Issues":
~ : Are YOU lobbvina on a [)endinG aoolication for a Develooment Aareement with the City or
aoolication for chanGe of zonino maD desianation or chance to the City's Future Land Use
Mao?
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..
~es 0 No: Are yOU reoresentina a not.for"Drofit corooration or entitY without sDeCial comoensation
or reimbursement.
V. SIGNAnJRE UNDER OA1H:
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 PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO ~1NDITU OR COM ENSATI N DURING THE
REPORTING PERIOD. )fit. ~
I do solemnly swear that all f the foregoing facts are true and correct and that I have read or am
familiar with the provisions c ntai . .on 2-4 2 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI,. L LJ'O BYIST IDE~TI';ICATION:() ~ ~
~~u~IDf~ ~
Form of Identification
~nallY known (Lobbyist)
PRINCIPAL IDENTIFICATION: ,
~edID~~
Form of Identification
D Personally known (Principai)
VII. SIGNATURE AND STAMP OF NOTARY:
t DO 626373
PIRES: May 3, 2011
BondId11lruNolalyNllcUncltrWrltn
KEFlRY HEIlNANDEz
~DMMlSSION' DOlI26373
EXPIRES: May 3. 2011
BOrn!c:.'"hr"NotarypUbleUndlrwltlela
u
tion of Lobbyist's si.gnature
/ FOR CLERK'
Annual Registration fee: [i/l'Yes [ ] No Amou t P .
Lobbyist Registration Forrfl received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 0
Dale Paid
Revised 12/08/04