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Carter N. McDowell/Robert Wennett UIA Management, LLC 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 commissions; any action, decision, recommendation of the City Manager or any city board or committee; or any action, decision or recbmmendation 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 r~viewed by the city commission, or a city board or committee. The tern specifically includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific xclusions. Please refer to Ordinance 2004-3435. (First) N. (M.I) NAME OF LOBBYIST: McDowell (Last) Carter Bilzin Sumbern - 200 South Biscavne Boulevard Suite 2500 Miami Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) Zip Code) em dowell""bilzin.com EMAiL: 305-350-2355 TELEPHONE NUMBER: 305/351-2239 FAX NUMBER: I. LOBBYIST RETAINED BY: Robert Wennett UIA Manaaement LLC NAME OF PRINCiPAUCLlENT: 1111 Lincoln Road Suite 760 Miami Beach Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305/538-9322 TELEPHONE NUMBER: 305/552-0016 FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] . NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Robert Wennett . IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: C) ~ - ~ ~ -I -< . ,..., '.m 0 ~ () r - 7.J r-> .......- - ~ ""0 ..:: tf> -.:J' \i1 0 N 0 -n ..,., t1\ C; c.1l ;on II. SPECIFIC LOBBY ISSUE: 1111 Lincoln Road 1665 Alton Closure of Lincoln Rd. Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Re ationship Members of Design Review Board, Planning Board,Board of Adiustment City Commission None Department Staff IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOS WHETHER HOURLY, FLA T RA TE OR OTHER) A) LOBBYIST DISCLOSURE: (Required) Houri 500 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). Houri 500 The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contri utions By Lobbyists On Procurement Issues": I] Yes IZINo: Are you lobbying on a present or pending bid for goods, equipment or servi es, or on a present or pending award for goods, equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By obbyists On Real Estate Development Issues": -,: Yes DNo: Are you lobbying on a pending application for a Development Agreement with th City or application for change of zoning map designation or change to the City's Future Land Use Map? 3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the def nition of "lobbyist" as set forth in Section 2-481 above) who only appears as a representative of a not-for-profit cor oration or entity without special compensation or reimbursement for the appearance, whether direct, or indirect, express support of or opposition to any item, shall register with the clerk as required by this section but, shall n t be required to pay any registration fees.. CJ Yes IZINo: Are you representing a not-for-profit corporation or entity without sp cial compensation or reimbursement. V. SIGNATURE UNDER OATH: ON OCTOBER 1" OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPEN ION RECEIVED IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHAL FILED EV N IF HERE VE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PER Signature of Lobbyist: miliar with the provisions I do' solemnly swear that all of the foregoi contained in Section 2-482 of the Mia . Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: State of Florida, Count SwoQ{ tp and subscribed before me This ~ day 0~"""""1_' 2 Signature of Public Notary - State of Florida Notarization of Lobbyist's signature Form of Id IlI8DIAZ MY COMMISStON. CD 529254 F N~18,2010 _nw_-- D Produced ID Form of Identifi ation D Personally known (Princip I) D Produced ID ~ Personally kn VII. SIGNATURE AND FOR CLE Annual Registration fee: [] Yes ] No Amount Lobbyist Registration Form received and verified by: F:ICLERI$ALLIMARIA-MILobbyistILOBBYIST FOR State of Florida, County of Miami Dade Sworn and subscribed before me This _ day of , 0_ Signature of Public Notary - Stat Notarization of Principal's sign Revised 12/08/04 JAM! t25 I I I ,I IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATtON (DISCLOSE \ HETHER HOURLY, ' FLA T RA TE OR OTHER) A) LOBBYIST DISCLOSURE: (Required) Houri" ~500 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). Hourlv $500 The following Information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributi ns By Lobbyists On Procurement [ssues": [I Yes IllINo: Are you lobbying on a present or pending bid for goods, equipment or services or on a present or pending award for goods, equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entill?d "Prohibited Campaign Contributions By Lob yisls On Real Estate Development Issues": IllI Yes [I No: Are you lobbying on a pending application for a Development Agreement with the ( ity or application for change of zoning map designation or change to the City's Future Land Use Map? 3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from thedefinlt on of "Iobbyisr' as set forth in Section 2-481 above) who only appears as a representative of a not-far-profit corpor tion or entity without speciai compensation or reimbursement for the appearance, whether direct, or indirect, to xpress support of or opposition to any item, shall register with the clerk as requIred by this section but, shall not b required to pay any registration fees.. 1'1 Yes IllINo: Are you representing a not-for-profit corporation or entity without speci I compensation or reimbursement. V. SIGNATURE UNDER OATH: ON OCTOBER 1" OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A IGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, I THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF TH RE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist i do solemnly swear that all of the foregoing facts are true and correct and that I have read or am fami iar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: "",,' ~,~, VI. LOBBYIST IDENTIFICATiON: ~ . TION: [ [ Produced ID 1,[ Produced 10 Form of Identifica on [,y/ Personally known (Principal) h A Leigh ,\\ 11I1'" Heat er . ...... Pll/;l~" 185-' gt;;.. ....;y;~Commiss\on #DD49 ~ . ,s~. ':~Expires: NO\' 17,200Y State of Flonda, County of Mla~, ~~.:- v,....,.;,w.AAR>,\;!\lO"r\R'i. \.: Sworn 2.[ld subscrIbed before me I, 11,,1' Thisb y ,20T Florida re Form of Identification II Personally known (LobbyIst) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed before me This _ day of ,20_ Signature of Public Notary - State of Florida Notarization of Lobbyist's signature FOR CLERK'S USE ONLY Annual Registration fee: [] Yes [ ] No Amount Paid MCR # Lobbyist Registration Form received and verified by: F:ICLERI$ALLIMARIA-MILobbylstILOBBYtST FORM 05.doc Date aid evlsed 12/08/04 AIAMJ J25