Kent Harrison Robbins/Mitch Novickm MIAMIBEACH
~~~~~~F~
City of Miami Beach Office of the City CIerIQ001 ~UP~ 29 F~1 S: 06
1700 Convention Center Drive, Miami Beach, FL 33139
CI t Y %LEr~'S Jt~F ii;E
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 lobbyi ivities. The term "Lobbyists" has specific exclus ons. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST:
l~~ ~~ ~~
BUSINESS NAME AND ADDRES
TELEPHONE NUMBER:
EMAIL:
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
BUSINESS NAME AND ADDRESS (Number and eet) (City) State) (Zp 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:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
~~. A ~ ~ sf~r~ ~ ~Gr~ ~ f~~~u IN ~~ v 11 Boa} t3-{ ~5` /c.
Issue o be lobbied (Describe in detail): S l n ~~~ ~~ ~T ~ $ ~~ $` ~~
1`- ~~pl (lN~ ~ i~t
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
r~ ~
~i i w ~~ ~ L
~~~ ,
(First) (M.I)
~~~
reet) (City) (State) (Zip Code)
~~
IV. DISCLOSURE OF TERMS AND
FLATRATEOR OTHERr
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
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":
^ Yes fOaNo: Are you lobbvina on a uresent or uendina bid for goods, eauioment or services, or on a
cresent or uendina award for goods~uiument or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
CYes ~o: Are you lobbvina on a cending auulication for a Development Agreement with the City or
aunlication for change of zoning mau designation or change to the Citv's Future Land Use
Mau?
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 anot-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..
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPEN ORES, AS WELL AS MPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR RE DING AR Y A STATEMENT
REPORTING PERIODEN IF THERE HAYS BEEN N PE D ORES RJ PE TI URING THE
Signatyl`e of Lobbyi
I do solemnly swear that all of a foregoi
familiar with the provisi c t ned in
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATI N:
Produced ID
Form of Identification
VII.
State of Florida, C~~~
Sworn to and bscri fore me
This Qay of , 200 7
.~iyi iacu~ c ~i ryuutcyyixai y - ;
Notarization of Lobbyist's
are tr a correct and that I have read or am
32 of a Beach City Code and all reporting
PRINCIPAL IDENTIFICATION:
Produced ID
Form f e ifi at'o~ ~ ,
•~~ OSELYN SAVWON
~f Personaly known (Pri ''~=wry pub _ ~ of Flalw
' ~NVC.omnNsdonE~DsC6~~
~:~ Commisalon #~ DD 376465
~,',~`t~'`'~ Sorxled
State of Florida, Coun SVNoMa~olNoloy~'
Sworn and subscribed before me
This,~day of , 20f~ ~ "
Signature of Pub c Notary to orida
Notarization of Principal's signature
- State of Floridi~
/FOR CLE, ONLY fJ / ,\
Annual Registration fee: ]Yes [ ] No Amount P ' MCR i~ U / Date Paid U
Lobbyist Registration Form received and veri by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST , R ised 1 /08/0
N11~MIBEACH '~~~`~I~Fr~
poor ~u~ i ~
City of Miami Beach Clffice of the City Cle Ql~ 1Q~ 36
1700 Convention Ce ter Dr've, Mia i B ach, FL 3313~f Y ~~- ~ s, ~; ';; ~ r ~ ,
LOBBY~)~GIS/ TRATI^O!V FORM r t:. r'.
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 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 city commission, or a city board or committee. The term specifically indudes the principal as well as any employee engaged
in lo~~yyng ad'vities. The term "Lobbyists" as spe 'fic exclusi s. Please refer to Ordinance 20043435.
NAME
I'
ES``S11NAME AND
V~5 ~
V
HONE NUMBER:
O5V 2~
FAX NUMBER:
~ ) (M.I)
~ ~+ ~~. Itu ~. i ~~k 3
and Street) (City) (State) (Zip Code)
L LOBBYIST ETAINE~D BJY: ~
NAME OF PRI CIPAL/CLIENT:
GDI~n I~"'1 Gl'n/ /
~ ~ ~ ~~ ~ 33
BUSINESS NAME AND ADDRESS (Number and Street) (Gty) (State) (Tp Cade)
~S --53 ~ - osd ~
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
out this section if prindpal is a Corporation, Partnership or Tnust [Section 2-482 (c)]
• -NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY_ISSUE:
r'C1~~CxA~lla~. Goilca
to be obbied (Describe in detail):
ld~rn~-~~ o~ 9~I ~~~-~ s~y~
~~ ~- o ~ ~~ -~7~~Pc~
IIL CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Finandal, Familial or Professional Relationship
a ®,~ P.- e r s o n ~ ~~~~y
~~~/~~~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OT7>IERf
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
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":
^ Yes ^ No: Are you lobbvino on a oresent or o ndina bid for goods eauioment or services or on a
uresent or oend~na award for goods eauioment or service
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes ^ No: Are you lobbvino on a oendina aoolication for a Develooment Aar ment with the City or
aoolicat~on for chance of zornna moo designation or change to the Citv's Future Land Use
Ma°?
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 anot-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..
[1 Yes ^ No: Are you reoresentina anot-for-orofit corooration or entity without suecial comoensat~on
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL
STATEMENT UNDER OATH, LISTING LOBBYING EN[
RECEIVED, IN THE CITY OF MIAMI BEACH FOR HE RE
SHALL BE FILED EVEN IF THERE HAVE BEEN N EXP N~
REPORTING PERIOD. D ®®®®®®
PRINCIPAL IDENTIFICATION:
Signature of
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar 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:
0 Produced ID
Form of Identification
^ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Swom to and subscribed before me
This day of , 20_
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
^ Produced ID
TO THE CITY CLERK A
AS L AS COMP I
A ND YEAR. A SI~
THE
Form of Identification
~~ Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This day of . ZO
Signature of Public Notary -State of Florida
Notarization of Principal's signature
FOR CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ) No Amount Paid MCR # Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\~ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc Revised 12/08/04