David Murphey/The Orange Bowl Committeem MIAMIBEACH
City of Miami Beach Office of the City Cferk
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 teen "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST: (Last) (First) (M.I)
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BUSINESS NAME AND ADDRESS (/Number and Street) (City) (State) (Zip Code)
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TELEPHONE NUMBER: FAX NUMBER: EM L:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CLIENT:
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code)
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FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal 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. p~, SPECIFIC LOBBY ISSUE:
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
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B) Any Financial, Familial or Professional Relationship `"
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER]
A) LOBBYIST DISCLOSURE: (Required) c;~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). c~
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 i~Vo: Are you lobbvina on a present or oendina bid for goods equipment or services or on a
present or pending award for ooods eauioment or service
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes [3'No: Are you lobbvino on a oendina application for a Development Agreement with the Ciri or
application for chance of zomna man designation or chanoe to the Citv's Future Land Use
MaD?
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..
or reimbursement. .
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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.
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/ 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:
signature of Principal/Client`:
LOBBYIST IDENTIFICATION: -
^ Produced ID
Form of Identification
Personally known (Lobbyist)
I. SIGNATURE AND STAMP OF NOTARY:
>,te of Florida, County of Miami-Dade
porn nd subscrib before me
is o~~d y of ~~iiJ,t.Q,W4~ , 20 a ~'
mature of Public Notary -State of Florida
itarization of Lobbyist's signature _ ~'
PRINCIPALIDENT TION: 1
~, i
d ced ID ~~'
Form of Identification
.N...II.
Personally know ~, r ~ aII,, KERRYHERNANDEZ
:. AMY COMMISSION # DD 626373
"~Pr';n°~0.~ ea~a d n,PNRES: May 3, 2011
~r wbn~ uneen~„
State of Florida, County of Miami-Dade
Sworn an ubscribb~ef~or~e me
This ya~ of ~~'_' 20~ `~'
Notarization of Princi
re
,/ FOR CLEL~~NLY ~ -
Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR ate Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc ao.,~ ,r , ~ Qinn
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (bI5CLO5E WHETHER HOURLY,
fLAT RATE OR OTHER
A) LOBBYIST DISCLOSURE: (Required} ,1'. _
B) PRINCIPAL'S Di5CLO5URE (OF LOBBYIST COMPENSA7ICN): (Required)._ t~,
The following information must be answered:
F) Pursuant to Miami Beach City Code Section 2-488. Entitled "Prohibited Campaign Contributions By Lobbyists
Cfn Procurement Issues":
ELYes [,4.f~o: Are you lobbying on a Wresent or Wending bid for goods eauinment or services. or qn as
present or Wending award for goods equi Wm~nt or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Rea!
Estate DevelopmenE Issues":
OYes o: Ar ou lobb in on a endin lication for a Develo ment A reement wi the Ci or
a lication for than a of z "n ma desi nation or than ` to th i 's Future Land Use
Mdp7
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 Z-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..
ar 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 7HE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE NAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD. ,_
` Signature of Lobbyist`- `
I do soiemniy swear that ail 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:~~
ignature of Principal/~IienC`
LOBBYIST IDENTIFICATION: ~~ -/
13 Produced ID
8 Form of Identification
~ ~ ~ Personally known (Lobbyist)
I. SIGNATURE AND STAMP OF NOTARY:
fate of Florida, County of Miami-Dade
worn nd subscrib before me
is d y of ~~, ZO f1 ~-
ignature of Public Notary -State of Florida
otarizatian of Lobbyist's signature
PRINCIPAL IDEN TION:
~Ptiiduced ID ,~~~i1~~ /~~-~-Q..
Form of Identification
,.,,", ,
Q Personally know a 1~FIAYHERhIANr?Q
' ;*= M1' COMMISSION t DD 6?63~9
.. 'a+ EXPItiFS: May3, 2011
nJ; h, ~ 9one.d 7hn, ~+yPubie n
State of Florida, County of Miami-Dade
Sworn an ubscrib before me
This ~ay of ~~' 20~} 7
Signaturer`of Put~t`c~lo~ary -State of Florida
Notarization of Principal's'signature
„/ FOR CLE~~C~ ~jpNLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid ~y(J~~ MCR ;~ ate Paid
Lobbyist Registration Form received and verified by: ~ ~~
F:\CLER\$ALL~MARIA-M~Lobbyist\LOBBYISr fORM 05.dac