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Amanda Quirke/Arthur Kline.~. m -- 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 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 boazd 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 heazd or reviewed by the city commission, or a city boazd 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. NAME OF LOBBYIST: (Last) (First) (M.I.) Quirke Amanda BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) TewCardenas, LLP 1441 Brickell Avenue, 15~ Floor, Miami, Florida 33131 TELEPHONE NUMBER: FAX NUMBER: EMAIL: (305) 536-8216 (305) 536-1116 AQ@tewlaw.com I. LOBBYIST RETAINED BY: Arthur Klein NAME OF PRINCIPALCLIENT: Kline, Moore & Klein 2665 South Bayshore Drive Coconut Grove Florida 33133 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 285-9793 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section it principal is a Corporation, Partnership or Trust [Section 2~82(c)] NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Arthur Kleln IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: M1Chae1 POpkin; Louise Popkin II. SPECIFIC LOBBY ISSUE: Variance Application III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship Jorge Gomez, Director None Richard Lorber, Planning and Zoning Manager None Diana Rio, Senior Planner None Antoinette Stohl, Secretary None r IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) X215 hourly B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required) $21$ hOUrly The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": ^ Yes !3'No: Are you lobbvine on a present or pending. bid for eoods, eauiament or services, or on a present or aendin¢ award for Foods, eauiament or service? 2) Pursuant to Miami City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^ Yes ,ElNO: Are you lobbvine on a aendine aaatication for a Develoament Aereement with the City or aoulication for chanee of zoning maa desienation or chanee to the Citv's Future Land Use Maa? 3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the defmition of "lobbyist"asset forth in Section 2-481 above) who only appears as a representative of snot-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.. ^ Yes ~IVo: Are you rearesentine snot-for-arofit corporation or entity without special compensation or reimbursement? IV. 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 EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. i Signature of Lobbyist 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 mall j~epo_rting requirements. Signature of Signature of PrincipaUClient: V. LOBBYIST IDENTIFICATION: PRINCIPAL H)ENTIFICATION: ^ Produced ID c~i ~ c ^ Produced ID Fonn of Identification ~ ^ N ~ Form of Identification ~a~~ Personally ]mown (Lobbyist) C7 c ~ z ^ Personally known (Principal) o ~+- o . VI. SIGNATURE AND STAMP OF NOTARY y ~ C ~~E'a Q State of Florida, County of Miami-Dade c 'Q 3 ' ~ State of Florida, County of Miami-Dade Sworn to and subscribed fore me ~ u S Sworn and subscribed before me This ~ ~ ' .o`~jc ~vp'~~, ~ ,... '~ This day of , 20 ' ~ QJ . o~ % ~ ' Signature of bl o e a p ~• i g(P p Signature of Public Notary -State of Florida Nntnri~nfin of in hvict'a cionnh~ra ~~H. ~ Nnrnrivnt:na of Pr:on:nohc ~:..,.qt..~o F CL 'S E Y Annual Registration fee: Yes [ ] No punt P i C MCR # V ate Paid V Lobbyist Registration Fonn received and verified F:\CLER\$ALL\MARIA-M\LobbyistUABBYIST ORM 0 oc Revised 12/08/04 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $215 hourly B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required) $215 hourly The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues":' ^ Yes C~'Iyo• Are you lobbvin on a present or pending bid for goods equipment or services or on a present or pending award for eoods• equipment or service? 2) //Pursuant to Miami City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": O Yes B'No• Are you lobbying on a pending application for a Development Agreement with the 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 definition of "lobbyist" as set forth in Section 2-481 above) who only appears as a representative of snot-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.. ^ Yes 6LNo: Are you representing snot-for-profit corporation or entity without special compensation or reimbursement? IV. 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 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 familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting requirements. Signature of Signature of PrincipaUClient: (r`l/"4 V. LOBBYIST IDENTIFICATION: ^ Produced ID Form of Identifcation ^ Personally known (Lobbyist) VI. SIGNATURE AND STAMP OF NOTARY State of Florida, County ofMiami-Dade Sworn to and subscribed before me This day of , 20 Signature of Public Notary -State of Florida Notarization of Lobbyist's signature PRINCIPAL IDEN'PI~AT [Produced ID Form o l tification ^ Personally known (Principal) State of Florida, County of Miami-Dade Sworn and subscribed before me This ~ day of 3KG , 20,0 +~'~ ~ y~~ 14icbelle I,oshusan~Duy: -~~~' ~ •~":Commisslan # QD28E127~ Signature is Notary- State o , .~@~ Expires; Feb. 08, 200E Notarization of Principal's signature'n,~H,''~,~.~` A3fOf1 K4t3i}I 1.600.35(I•~16' 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 O5. doc Revised 12/08/04