Thomas R. Roth/Howard Herring NWS
,
&
.....
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, dedsion, recommendation of the
Oty Manager or any city board or committee; or any action, decision or recommendation of any city personnel during the time
period of the entire dedsion-making process on such action, decision or recommendation that foreseeably will be heard or reviewed
by the dty commission, or a city board Or committee. The term specifically induc:les the principal as well as any employee engaged
in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
RO+h
~--_._-
NAME OF LOBBYIST:
IhoYntl S
(First) (M.!)
Blvd. sh 2zS" Co,.",! G ~ u rL 33/3'-1
(Number and Street) (City (State) (Zip Code)
(joS-J'iLf'f-0/6'1 fOI'n-rofhta),ihe..r.cO?1
FAX NUMBER: EMAIL:
R
(Last)
I e s 2.5">"S" f.I,'~ dl- Leol-)
BUSINESS NAME AND ADDRESS
(305") '1'f~- 5"35"0
TELEPHONE NUMBER:
I. LOBBYIST RETAINED BY:
J.}OWIH-J Iterho", q
NAME OF PRINCIPAl/CliENT: J
- AI-l1IV
w.",
SVI'I1I'J,.;,v
r. /
miqrn 0
ity)
FL 3J/31
(Zip Code)
!) /
BUSINESS NAME AND ADDRESS
30 S" - G 13 - 333 0
TELEPHONE NUMBER:
Li~c.o ,
(Number and Street)
30~- (,iJ-C7L1?
FAX NUMBER: (Optional)
EMAIL: (OpUonal)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2--482 (e)]
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
. IDENTIFY ALL PERSONS HOLDING, DIREGLY OR INDIRECTlY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
o. SPECIFIC LOBBY ISSUE:
A/{Vv WorlJ ~ i'h Ph....v
Issue to be lobbied (Describe in d i1): I I
carry '" \-
.ex of/A rion
/
01. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) full Name of Individualmtle
B) Any financial, familial or Professional Relatlonshlp
d).{ Ii
ff30f/i'rI
;VOi-J <-
A(;I....t
.
,
"*
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FI.ATRATE OR OTHER): ~
A) LOBBYIST DISCLOSURE: (Required) _" I/t'I
I
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required)"_
d/" -
/'
/
I!IZ
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":
No: Ar u lobb in on a ent or endin bid for oods e ui men or services or on a
Dresent or Dendina award for Qoods. eauicment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
o No: Are au lobb in on a endin a Iication for a Devel ment A re men with he Ci or
8DDlication for chanGe of zonino 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..
~.
No: Are YOU reDresentina a not~for-Drofit corDoration or entity without sDecial comDensation
\ or reimbursement.
V.
SIGNATURE UNDER OATH:
ON OCTOBER 1 Sf OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDIN CALEN AR YEAR. A STATEMENT
SHALL BE FILEO EVEN IF THERE HAVE BEEN NO EXPENDIT 0 PENSATION DURING THE
REPORTING PERIOD. A"
I do solemnly swear that all of the for
familiar with the provisions contain
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
true and correct and that I have read or am
of the Miami Beach City Code and all reporting
~
VI.
LOBBYIST IDENTIFICATION:
PRINCI~L IDENTIFICATION:
o Produced ID
o Produced ID
Form of Identification
Form of Identification
~rsonallY known (Principal)
~Personally known (Lobbyist)
VII.
SIGNATURE AND STAMP OF NOTARY:
~:~ OMACAROLPETROCY
':1 ~..1 MY COMMISSION # 00591*
"'?-"'f\~- EXPIRES; Aiig, 31. 2010
State of Florida, County of Miami aCW(7) 398-01S3 RortdaNoterySaMce.com
Sworn and subscribed before me
This d!l:rtiday of -.:Ji!,.x1/l11-Y . 20g
Signature of Public Notary - State of FI r a
Notarization of Principal's signature
R LERK'S USE ONLY
Annual Reglstrat;on fee: [ ] 0 Amount Paid D) MCR # (<:..)
Lobbyist Registration Form received and verified bY~.J..~
F:\CLER\$ALL \MARIA-M\Lobbyist\LOBBYIST fORM
Date _
1/2~t
I
Revised 12/08/04
ATTACHMENT
Jorge M. Gonzalez/City Manager
Timothy Hemstreet/Assistant City Manager
Hilda Fernandez/Assistant City Manager
Robert C. Middaugh/Assistant City Manager
Jose Smith/City Attorney
Robert Parcher/City Clerk
Maria Martinez/Assistant City Clerk
Donald M. Papy/ChiefDeputy City Attorney
Jean Olin/Deputy City Attorney
Raul J. Aguila/First Assistant City Attorney
Kelli CohenlFirst Assistant City Attorney
Rhonda Montoya HasanIFirst Assistant City Attorney
Gary M. HeldlFirst Assistant City Attorney
Sheri A. SacklFirst Assistant City Attorney
Debora J. TurnerIFirst Assistant City Attorney
Judith L. WeinsteinIFirst Assistant City Attorney
Jeffrey T. Donner/Senior Assistant City Attorney
Steve H. Rothstein/Senior Assistant City Attorney
David Dermer/Mayor
Saul GrossNice Mayor
Matti Herrera Bower/Commissioner
Simon Cruz/Commissioner
Luis R. Garcia, Jr.!Commissioner
Jerry Libbin/Commissioner
Richard Steinberg/Commissioner
Kent Bonde/City Center Coordinator - Redevelopment Agency
Patricia D. Walker/Chief Financial Officer (City Finance Director) - Redevelopment Agency
Alexandra RolandellilSouth Pointe Coordinator - Redevelopment Agency
Stacy Kilroy/Redevelopment Specialist - Redevelopment Agency
. .
Manuel Marquez/Financial Coordinator - Redevelopment Agency
Sandra Ortiz/Office Manager Redevelopment Agency
Thomas Mooney/AICP, Design and Preservation Manager