Grant R. Stevens/Howard Herring
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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 pel'SOOS empkyed or retained, whether pilid or not, by a Plindpill who seeks to encourage the pClS5age, defeat
or modification of any ordinance, resolution. actkln or deciSion of any commissioner; any action, dedSon, recommendation of the
City MMilger or any dty board or committee; or any action, decision Of recommendation of any dty 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 dty commissiOn, or a city board or committee. The term specifically includes the prilldpal as well as any employee engaged
in lobbying activities. The term "Lobbyists" hilllpedfic ucluslonl. Ple.s. refer to Ordln.lnce 2004-3435.
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NAME Of LOBBYIST: (Last)
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(Rrst)
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fA 6,A 30301
(Zip Code)
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BUSINESS ME AND ADDRESS (Number and Street) (Oty) (State
(4~ t:l7C;-40S'2- (4-<>4-) q1~- 4-C51
TELEPHONE NUM : FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAl/CLIENT:
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~ 1iJ0/Zt0 '7'fIVoRItt>/J'1 I 04\ Ur-J~t-J fokO MIA::llA.\ ~( f'L-
BUSINESS NAME AND ADDRESS (Number and Street) (aty) (State) I (Zip COde) '? -51 ~ 1
(<;Oq~ 67'?-?7?D (7D~:)"1?-0'WI l.DWtlvti.l--Q(r'-l'4I6!l-I (),J
TElEPHONE NU aER: FAX NUMBER: (Optional) EMAIl: (Optional) J - \OS. V
fill out this MCtion if prtndpilllI a Corporiltion, p;artn.rlhlp orTrust [SKtion 2-482 (en
NAME OF CHIEF OFFICER, PARTNER, OR BENEFlOARY:
IDENTIFY ALL PERSONS HOLDING. DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATJON" PARTNERSHIP OR TRUST:
D. SPECIFIC LOBBY ISSUE:
t-J g.V wOZtO qy WfR&tt;t-J'i
Iuu. to be lobbied (Describe in detail):
nL CITY AGENCIfS/INDMDUALS TO H LO'BUD:
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A) FuU Name of Indlvidualrntie B) Any flnandill, Filmllla' Of ProfusIon.1 RehltJonshlp
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A} LOBBYIST DISCLOSURE: (Required)
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IV. DISClOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL~
FLAT RATE OR OTHER):
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required),
The rollowing Information must. be answered:
1) Pursuantta Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Jssues":
n Yes ~o: Are YOU lobbvino on 8 oresent or GeRdinG bid for Goods. eauloment or services. or an a
ora.eM or oendino award for DOods, eouioment or service'
Z) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
~ n No: Are YOU lobbvlna on 8 oendinG aoollc.ation for a DeveloDment Aareemll!!nt with the City or
aDDII~atIDn for chanGe of zonlna maD desianation Dr chll"!:"!! t'o the City's Furor", land Use
IiOJ!Z
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 cleri< as requIred by this
section but, shall not be required to pay any registration fees..
~_ n No: Are you renresentina a nat~for~Droflt camoratlon or entity without sDP.r.ial cam!H!nsatlon
or reimbur_mll!!nt.
V, SIGNATURE UNDER OATH:
ON OCTOBER 1 Sf OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WEU AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PR DING CALEND YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPEN U R CO ENSATION DURING THE
REPORTING PERIOD.
I do solemnlv swear that all of
famlliar with the provisions contai
requIrements,
Signature of Lobbyist:
SIgnature of PrindpallClient:
VL
LO'.Y1ST IDENTIfICAnON:
a Produced ID
Form of Identification
X Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of florida, County of Miami-Dade
Sworn to and subscribed before me
Thl$_dayof ,20_
cts are true and correct and that I have read or am
f e lami Beach City Code and all reporting
PRINCIPAL IDE
nON:
o Produced ID
Farm of Identification
XPersonally known (Principal)
#~'~ OMACAROLPETROCY
",V !!II MYCOMMISSION#DD591284
~~Of~" EXPIRES: Aug. 31, 2010
(401) 39M1153 FlorIda Notary ServIoe.oom
Signature of Public Notary - State of Florida
Notarization of Lobbyist'. signature
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1 Y;I;\, FORCL~S'ONLY $. I 1.5'
An n ~:-T Yes { J No Amount Paid MCR # Date'- \ 7~ ~
LobbvlstR.egistratlonFormreceIVEdandverifiedby:~ - I I
f:\CLER\$AlL\MARIA-M\LobbyJst\LOBBYIST fORM 0 Re'o'lsed 12108/04
SIgnature of Public Notary - State of Aorida
Notarization of Principal's signature
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ATTACHMENT
Jorge M. Gonzalez/City Manager
Timothy Hemstreet/Assistant City Manager
Hilda FernandezJAssistant City Manager
Robert C. Middaugh/Assistant City Manager
Jose Smith/City Attorney
Robert Parcber/City Clerk
Maria MartinezJAssistant City Clerk
Donald M. Papy/ChiefDeputy City Attorney
Jean Olin/Deputy City Attorney
Raul J. AguilalFirst Assistant City Attorney
Kelli Cohen/First 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.lCommissioner
Jerry Libbin/Commissioner
Richard Steinherg/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 MarquezlFinancial Coordinator - Redevelopment Agency
Sandra Ortiz/Office Manager Redevelopment Agency
Thomas Mooney/AICP, Design and Preservation Manager