Michael J. Kurzman/Team Contracting, 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 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 term "L,o~bbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST: (Last) first) (M.I)
Siegfried, Rivera, et al. 8211 W. Broward Blvd., Suite 250
BUSINESS NAME AND ADDRESS (Number and Street) (City) State) (ip Code)
Plantatidn FL 3332
(954) 781-1134 (954) 465-2590 Mkurzman@sieafriedlaw.ca~n
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Team Contracting. Inc. - Rudy Aye, V; Pr id.n-
NAME OF PRINCIPAL/CLIENT:
13911 SW 42 Street, Suite 20 Miami, FL 33173
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code)
(305) 207-9799 (305) 207-9790 fnlrudv@aoL com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
out this section if principal is a Corporation, Partnership or Trust
• 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:
Item R7C Approving and Authorizing of Funds and Award of Contract
Issue to be lobbied (Describe in detail): t0 the Tower Group
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
c
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLATRATEOR OTHERr ~ C~
A) LOBBYIST DISCLOSURE: (Required) D V ~ t"~ '~ , /
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). X16_ V IK r:-~ ~~ ~ ~
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 lobbvina on a present or pendina bid for aoods eauipment or services, or on a
~ present or pendina award for aoods, eauipment 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 lobbvina on a pendina application for a Development Agreement with the City or
application for chanae of zoning map designation or chanae to the Citv'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
se//coon but, shall not be required to pay any registration fees..
^ Yes CNIo• Are you representing anot-for-profit corporation 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 PRECEDI G CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITU~S OR COMPENSATION DURING THE
REPORTING PERIOD. _ ~)
/ Signature of Lobbyist
I do solemnly swear that all of the fo egoing facts are true and correct and that I have read or am
familiar with the provisions contained~n Section 2-482 of the Miami Beach City Code and all reporting
requirements. _ ~ /
Signature of Lobbyist:
*'Signature of Principal/Client:
VI.
c ~ ~ Form of Identification
~ ~ ~ ~ Personally known (Lobbyist)
z ° ~
~ e o° SIGNATURE AND STAMP OF NOTARY:
m N !
Z ~ "' o e of Florida, County of Miami-Dade
= a 'a
°m a' . .~ rn t and subscribed before me
~t~`-day of Itii7v~nr.-~r~2o~`
o v -- ~ ~ _
Z ~ ~L~ Ci. ~--`:7
e°~~"~';~,, Si nature of Public Notary -State of Florida
;e/~j,°b;~V tarization of Lobbyist's signature
xPRINCIPAL IDENTIFICATION:
Produced ID
Form of Identification
Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This day of , 20_
Signature of Public Notary -State of Florida
Notarization of Principal's signature
- FOR CLER 'S USE ONLY
ual Registration fe~ ]Yes [ ] No Amount P id MCR Date Paid
Lo byist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 0 ~j ~ • Revised 12/08/04
/LOBBYIST IDENTIFICATION:
~/ Produced ID
~ Ti/~/~ 7
IdOV.20-2007 TUE 0321 PM SIEGFRIED,RIVERA FAX N~, 0544652590 P. 02/03
NUU-2U-2ao~i ?UE 02:28 Pt[ sIEGFRIEb,RIVERA
FAX K0. 9544652590
l~~Al~lil BEAC~-I
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17Q0 COnVention Genttzt Drive, Midmi Beach, R 33139
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aN QOM or ~M da ooant or oomnMtOOO: or any radon. d~,rfsfon or ramrntrndatjm ~ a"v atr t~r
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ru. o~ozutt+o a t~pNa ato awout~ts of ~olse+rssT m~isr-TSOY tmsa,~ wNrn+~t Mauiur,
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c~orpoacor- or Bra v+ftitiout ~pacW campeneado• ~ or ndmburscrrxmt Aur t-te apptarar~oe, wN1YtnYr airsQ Or
InaMecG fa eipre55 supD~ d' or opponnrn to inry loern, Sf-ali nepi~!r MIUi (f1e dent a9 Pbquired W tuts
paion true SftaA nue be reCUir+Nt m pav any repistratbn fees..
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ON OCTD~ 1"~ Of ~N YEAR. !'~ tD~Y1l1~ ~LL filslMtT YO TN! Ct<rT/ CLe1MC R StAlIbD
bTA'flr'NRNY !MDlR QA'Tfi, 1,7'~tAiR WBiYtN6 t~N'fD>tTtt~+ AB 1M~LL A~ CaMOEIrSATiOM
1>lt~lM'Dr IN 7H6 CITY aF NIANL elAL.Y# !'O41'NL CJLBIaAR Y~Q- A SYAYL~INT
•11ALL fI[ fI>G.ID Ct16i1 D' YN~i MA» ~l GD t OR [R11~Ttrt11 dll1N6 Ttt&
RL'PORTII~IG P@tiOD. ~I
57gni ar tdaA~iet
Y do ademniy 9uaear than au of tl+a ng Mch, are ttut anti oorreet and tfiat Y have read or am
familltar udttt ttra provl5lornt mn®It1C~ Se[.Lon 2~-~'>N2 of U1e Mtanli 8~d- CiQ/ C~ dnd all reportt~9
re~ulremtnt~ ,,, „ 1
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