Ronald Shane/Miami Beach Watersports Center, Inc.m 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 dty board or committee; or any action, dedsion or recommendation of any city personnel during the time
period of the entire decision-making process on such action, dedsion or recommendation that foreseeably will be heard or reviewed
by the dty commission, or a dty board or committee. The term speafically indudes the principal as well as any employee engaged
in bbbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST: (Last) (First) (M.I)
rytd~t8f~~i~°S~zS ~-wr;,i~1(', „~~o ~a~r~xr ~ ~ ~°, ~~I~l
BUSINESS NAME AND ADDRESS (Number an Street) (City) ) (Zip Code)
30~ ~I R~7,6 ~o ~ I ~~~!
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOB,~B,Y,~I~ST, RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code)
305" ~/ XX7~ 3~ ~6/ ~1G/
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Ootionall
FII out this section ff 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:
/~Y
II. SPECIFIC LOBBY ISSUE:
Issue to be k>bbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
~~
B) Any Financial, Familial or Professional Relationship
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
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A) LOBBYIST DISCLOSURE: (Required) nJC~~
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 pf No• Are you lobbvina on a present or Wending bid for goods eauiument or services or on a
pre~pn* or Wending award for goods eauiument or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
. E/state Development Issues":
^Yes dYNo• Are you lobbvina on a Dendina application for a Development Agreement with the City or
-+lication for change of zoning map designation or change to the Citv's Futu n se
Man?
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..
~.~Yes ^ No Are you representing a not for profit corooration or entity without special compensation
or reimbursement. .
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 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 Lobbyist: ~r,~L.l P,~ ~~---
Signature of Principal/Client: ~ one G~ ~~~-.
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
^ Produced ID
PRINCIPAL IDENTIFICATION:
Form of Identification
I.a~Personally known (Lobbyist)
NOTARY PUBLIGSTATE OF FLORIDf~
VII. SIGNATURE MP ~~c'~~~A~~~len
State of Florida, County _ o mission #DD3782'~8
Swom to and subscribe ~~~~e'' DEC, 09, 2008
r~,cie Bonding CR., tnc.
This ![L. day of ~J
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
Form of Identification
L0'~ersonally known (Princi Q~ARY pUBLIC•S'G~,TE OF FLORIDA
Elaine Roden
Commission #DD378278
Expires; DEC. 09, 2008
State of Florida, County of ~htile@adeu arl~+dp isnadtn~ Co.+ Ina,
Sworn and subscribed before me
This ~_day of BUG , 20~
~i~ !h
Signature of Public Notary - Sta a of Florida
Notarization of Principal's signature
FOR CLE K'SR NNLY _
Annual Registration fee: ]Yes [ ] No Amount P ' NO MCR # x Date Paid
Lobbyist Registration Form received and verified by: ~~ o
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc "¢-~1 .Revised 12/08/04