Kent Harrison Robbins/Charter on the Beach Middle School
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MIAMIBEACH
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 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 "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
~/N,S ~2;\J'\ tffl~~/SO;0
NAME OF LOBBYIST: (Last) (M.!)
I ~ uUlts' II J,J IC- ~ l33/:::rJ
BUSINESS NA E AND ADDRESS mber and Street) (City) (State) (Zip Code) - /
des -53;;-0500 .3 05 -63 J - OISu kl.H<OOOjt->5'O)KEiJTHtt~\.)C.\J l?o6aiNs
TELEPHONE NUMBER: FAX NUMBER: EMAIL: ' COli
I. LOBBYIST RETAINED BY:
j\\ l P-. f+-Cb R- l;:).OO Cor~ f\.\ IN \ U Nt &S.sOCI AT/O N: 'L~, tA ~tJ-pt2-(l~ICv R?
NAME OF PRINCIPAL/CLIENT:
\ aDD VveST- ftVE i tv1/t-h1t1 {3clftcti, F'-
BUSINESS NAME AND ADDRESS (Number and Street) (City) ,
33,:;9
(State)
(Zip Code)
TELEPHONE NUMBER:
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:
I- ,r.t R. (;< 'I V\) t= X I f::: K) ? (2.~S-1 ~~I\J I
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II..... SPECIFIC LOBBY..ISSUE: c. - ,~:> . ^ Jct dC\L.::::-\. O~k r .-,..... ,. SSUc' ('. t'!"",5',NI (J ~f)AA
Li;bl't\ REP~S'ENTAI/ON ~bNctc"'-NII~ I-v=- f7'lclJ I' C,.J (1- :....J \-~,.\..
f\-l\ t...1 c.~ V ?LA. . R "\- Bud -gj)"hT I CtFtIO~JS. . 1100 'v\Ji=~,:/
Issue to be lobbied (Describe in detail): A- \I t::: 'N () E:: <f-- '\::: L-A-lED
\ SSu c5
III.
CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
D R~ N ON -
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"PI ItNN I~j D c?t;-\~(Y) E. NT N 0 Nt:.
CI\~ (v) A N NOi'J ,--
q q-E(rlE N\ 't:.-
11 ~ I C'J t^ -::f -2.' 11- 5"7"(Y] C lJt 'I eN
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Y Co f\\ 1\'1 L~S IOvJ
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLATRATEOROTHER): -$l J '2. / 5. '.
A) LOBBYIST DISCLOSURE: (Required) <"'-t_
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
JJr~
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":
DYes ment or services or on a
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate evelopment Issues":
DYes
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..
ion
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 COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR T E P ECEDI G CALEND YEA. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO P R S OR C ENS N DURING THE
REPORTING PERIOD.
\.<0,1 ~I..' J~Cc~!{c
As~c( ,
I do solemnly swear that II t
familiar with the provisio s' 0 t
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
I! Produced ID
I Produced ID
Form of Identification
Form of Identification
)( Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, Coun
Sworn and subscri
Thi~"l day of
", V. ROSElVN SAVINON
"\ Notary PublIc - State Of Florida
'~E':lirJll8sDec5.2am
l Commlaslon # 00 376468
.' By NatIonal Notary Assn.
State of Florida, County of Miami-Dade
Sworn to and subscribe before me
This day of ,20::1
Signature 0 Pu ic Notary - State 0 Florida
Notarization of Lobbyist's signature
/ FOR CLE
Annual Registration fee: [/] Yes [ ] No Amount Pa'
Lobbyist Registration Form received and verified by:
F: \CLER\$ALL \MARIA-M\Lobbyist\LOBBYIST fORM 05.d
'SYSEONLY .-r/ "'7/~/Jt '""J....--
;;:z 5 MCR #~ xt!t / ~ Date Paid --=>:....P'I "'7
Revised 12/08/04
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MIAMIBEACH
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 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 "Lobbyists" has S~ecif'j exclusions. Please refer to Ordinance 2004-3435. !
-Ro,B5 l~ t< t ~ ttA rq? 1,-5 0 ~.J
NAME OF LOBBYIST: (M.!)
(dd. '-t WAs I CZ ,~~
BUSINESS NAME AND ADDRESS (ber and Street) (Zip Code)
3D -5;:" -Q,C'm
EMAIL:
I. LOBBYIST RETAINED BY:
C MP. IE R 01-J -rlf-E &~Ac d /11 (DDLE ScHa) (J;V::~'I A NO~J~?2ct;...I'1/)
NAME OF PRINCIPAL/CLIENT: C:O~l(,
CflO 68\ O.<)v:- n (1/ ft "7-33tL/ / UlJ/F'#l7-
BUSINESS NAfvlE AND AD ESS (Number nd Street) (Zip Code)
7glo - ~~,~~-,:}5:JS
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
r, . NAM~.OF CHIEf OFFICER, PARTNER, OR BENEFICIARY: fl.. '~_, . ,
G-\ A 'D ~ ~ PA / AC I lJ/::) Ctt:tJ! VI (2i=:cTol<
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II.
SPECIFIC LOBBY ISSUE: I- [;: G A I
1!141 US"E
CbNCE~NlrV5
I' f I rJ B()fJR~
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
\)
CoAf!
N (J N f::::--
,
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). -
rL
The following information must be answered:
1) Pursuant t Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Pro ement Issues":
DYes
2) Pursuant Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
evelopment Issues":
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, . express support of or opposition to any item, shall register with the clerk as required by this
secti but, shall not be required to pay any registration fees..
nsation
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 EXPEN ITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRE EDING CALEND YEAR. EMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EN ITURES 0 M ENSATI THE
REPORTING PERIOD.
Signature of Lobbyist:
Signature of Principal/Client:
reet and that I have read or am
h City Code and all reporting
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
Produced ID
I Produced ID
Form of Identification
Form of Identification
known (p~~~EZ
. i'~Notary'Public . Staia of Florida
: . ~rvfyCornrrlmbnExpies~20. 2008
~....:;.; >~~ Commission # 00311428
",t,cf, F\.~\\'\.. INn.
FOR CLERK'S USE ONLY . I / ........,
Annual Registration fee: [/,] Yes [ ] No Amou~~ :3- S- MCR # e.:ti 9'~ Date Paid ..!J! i " /0 -r
Lobbyist Registration Form received and verified by: ~_ '
F: \CLER\$ALL \MARIA-M\Lobbyist\LOBBYIST fORM 05.doc Revised 12/08/04