Michelle Plowey/The Ronald W. Shane CenterMicrosoft Word -LOBBYIST fORM new logo OS.doc
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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
in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 20043435.
NAME OF LOBBYIST: (Last) (First)
P~ow~ey ~~~,h e/le
(M.I)
BUSINESS NAME AND ADDRESS (Number and Street) (City (State) (Zip Code)
fiS'DO ? d~ ~n Cie~~ ~ ~
jNUMBER: FAX ~ NUMBER: EMAIL: /
TELEPHONE 3t7$~'~!/I ~~~ c.~Or-~-G(-' ~'a•'N/ /y11c..CallG~.r~J4hL°.
C E~J ~i+, G ~Jr~
1. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
BUSINESS NAME AND ADDRESS (Number and Stre ,/
~~~G /~~~~ fN ~ p7t° ( 6'^^2 j~ ^ (City) (State) (Zip Code)
~ ~ ,dew , r-~. 33.yi
NUMBER: FAX NUMBER: (Optional) EMAIL:
TELEPHONE
3or-~1/'~-~''~~ 3vC'-~i -/if~j ~'j~~c.~,//c @ J'l'.I?~ie c~,.~, ~as~s.~
Fill out this secfion if principal is a Corporafion, Partnership or Trust [Section 2-452 (c)J
? NAME OF CHIEF~OFQFICE~R, PARTNER, O,R/BENEFICIARY:
? IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5 % OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
Il. SPECIFIC LOBBY ISSUE:
VCS G'.~r~
Issue to be lobbied (Describe in detail):
II[. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
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Microsoft Word -LOBBYIST fORM new logo OS.doc
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N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER
FLAT RATE OR OTHER)
A) LOBBYIST DISCLOSURE: (Required) V
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). O
The following information must be answered:
I) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
Yes~o: rare you lobbying on a present or pending bid for goods, equipment or services, or on a
~`J present or pending award for goods, equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
Ye No: re 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 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 anot-for-profit corporation or entity without special compensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1 sT 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 RING THE
REPORTING PERIOD. -
f
Sig afore 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~c-o~nta/in~ed in Section 2-482 of the Miami City de and all reporting
requirements. i'~ X~-l~l i1 /I /I ~1
Signature of Lobbyist __~
Signature of Principal/Client: ~6~[~_ W~~ ~ CJ
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification
Personally known (Lobbyist)
Form of Identific
Personally known (Principal)
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Microsoft Word -LOBBYIST fORM new logo OS.doc NOTARY pUguC.STATE OF FLORIDA page 4 of 4
C STA'S'E OF FLORIDA Elaine Roden
NOT~tY PIJBU ~ .Commission #DD378278
Elaine Roden ~xpir~s: DEC. 09, 2008
Bonded Th*u A~and° 8endlnt Co'{ teta~
- Commission C D09 78278
Expirzs: ~- ~ S"~~TURE AND STAMP OF NOTARY:
BondedThru Atlantic Boadinq Co., tnc.
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn to and subscribed before me Sworn and subscribed before me
This day of ~_, 20~ This day of , 20Q 7
Signature of Public Notary ?State of Florida Signature of Public Notary ?State of Flon
Notarization of Lobbyist's signature
Notarization of Principal's signature
~p ~ (~y~(~'('~?p~~R CLERK'S USE O/N'~L
Annual Registration fee. ]Yes [ ] No Amount Paid VW ~ r' MCK # ~ ~. ~~ Date Paid C1
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\ Lobbyist\ LOBBYIST t1DRM o
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