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H. Hugh "Terry" McConnell/A2 Group, Inc. lD '~ MIAMI BEACH City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM NAME OF LOBBYIST: Siefgried, Rivera, Lerner, De La Torre, & Sobel BUSINESS NAME AND ADDRESS 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 commissioner; any action, decision, recommendation of the City Manager or any city board or committee; or any action, decision or recommendation 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 reviewed by the city commission, or a city board or committee. The term specifically includes the principal as well as any employee engaged in lobbying activities. The term ftLobbyists" has specific exclusions, Please refer to Ordinance 2004-3435. McConnell ( II Terry ") H . (Last) (First) 201 Alhambra Circle, #1102, Coral Gables, (Number and Street) (City) N V (.~ h FL (M.1) 33134 FAX NUMBER: (State) (Zip Code) tmcconnell@siegfriedlaw.com EMAIL: 305-442-3334 TELEPHONE NUMBER: 305-443-3292 I. LOBBYIST RETAINED BY: Alberto G. Ribas, P,E. - President NAME OF PRINCIPAljCLIENT: N Group, Inc, BUSINESS NAME AND ADDRESS 7300 N. Kendall Drive, #340, Miami, (Number and Street) (City) 305-668-9454 FAX NUMBER: (Optional) FL 33156 (State) (Zip Code) ribasa@a2group.com EMAIL: (Optional) 305-668-8939 TELEPHONE NUMBER: Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] . NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Alberto G. Ribas, P.E. - President IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Alberto G. Ribas, P,E. - President II. SPECIFIC LOBBY ISSUE: South Pointe Park Improvements 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 Relationship City Administrative Staff No City Administrative Staff No City Administrative Staff No IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLA T RA1F OR OTHER). Hourly A) LOBBYIST DISCLOSURE: (Required) B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required), $400.00 per hour 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": (I'f Yes n No: Are YOU lobbyina on a oresent or oendina bid for aoods. eauioment or services. or on a oresent or oendina award for aoods, eauioment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By LobbyiSts On Real Estate Development Issues": DYes ~No: Are YOU lobbyina on a oendina aoolication for a Deyelooment Aareement with the City or aoolication for chanae of zonina mao desianation or chanae 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.. DYes g'No: Are YOU reoresentina a not-for-orofit corooration or entity without soecial comoensation or reimbursement, V. SIGNATURE UNDER OATH: 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 EXPEND ""'f D1COM'lNS,ATION rING THE REPORTING PERIOD. /0"" ~ 'I ((~ Signa re of Lobbyist I do solemnly swear that all of the foregoi familiar with the provisions cont~ned i Se requirements. 1 !. Signature of Lobbyist: 'I j" Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: .....~ ~La.~ Tn i~~:)' MY COMMlSSlotrfOij~ ~ 'i EXPIRES: November 14, 2008 ~t -, :~\ ~ Bonded lhru NcUry PliJlic Undefwriters D Produced ID Form of Identification Form of Identification (Lobbyist) ~~~V PUs KARLA SAlGADO 6!'l' Personally known (Principal) ~O .,...,. ('0 * ..~, * MY COMMISSION # DD 309712 ..~". EXPIRES: April 12, 2008 ~r" OF f\.rff:"O Bonded ThN Budget Notary Services State of Florida, County of Miami-Dade Sworn ~p.d subscribed be~e me This ~day of f...la.t , 2007 ~~Ado Signature of Public NotarY - Stat of Florida Notarization of Principal's Signature VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn tQ ~ndlsubscrib efor~ me ? is j' day. Q 1u,- 20-2 /I. / l , ~L / '--"'" Signature of Public Notary - State of Florida Notarization of Lobbyist's signature , / FOR CLERJeSlJ~ ONLY Annual Registration fee: [ V] Yes [ ] No Amo()nt Paid \ :;c.J. ........-MCR # 2~T'\CJ Lobbyist Registration Form received and verified bY~c::>.-\~~ F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 0 , oc Date Paid 3/l<\ I~r- Revised 12/08/04