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Jay Beskin/Regal Entertainment Group~n~~n~i=~~, . ~ 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 prindpal who seeks to encourage the passage, defeat or modification of any ordinance, resolution, action or decision of any commissioner; any action, derision, recommendation of the City Manager or any city board or committee; or any action, derision or recommendation of any city personnel during the time period of the entire decision-making process on such action, dedslon or recommendation that foreseeably w11 be heard or reviewed by the city commission, or a city board or committee. The term specifically indudes the prindpal as well as any employee engaged In lobbying activities. The term "Lobbyists' has speciFc exclusions. Please refer to Ordinance 2004-3435- . U OF LOBBYIST: (Last) (M.I) Gra Robinson, P.A. 401 E. Las Olas Blvd. Suite ~ts~u rlor ~ Z, Code) BUSINE55 NAME AND ADDRESS (Number and Street) .(City) (State) (~P 954.761.7474 954.761.8112 rlewis@gray-robinson.com FAX NUMBER: EMAIL: TELEPHONE NUMBER: I, LOBBYIST RETAINED BY: Regal Entertainment Grou NAME OF PRINCIPALf CLIENT: BUSINESS NAME AND ADDRESS 865.925.9414 T~-. r-ni.nnlL n111MQCD• FAX NUMBER: Fill out this section if pringpal u a or Trust [Section 2-482 EMAIL: NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Rob Del Moro, Chief Purchasing Officer IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MDRE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Publicly traded company II, SPECIFIC LOBBY ISSUE: Issue to be lobbied (Describe in detail): rrr CiN AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship Miami Beach Mayor's Office Miami Beach Commission No Miami Beach Planning Board No i ~ - Miam - Miami Beach City Manager No ; 7132 Regal Lane Knoxville (Number and Street) {City) 865.925.3621 TN 37918 (State) (Zp Code) rob.delmoro(a~rega com ncoln Rd. ~.1! ~ 'BOOT {~~h,l~J~~3. IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATF OR OTHER): Flat rate $25 000 paid to Gray Robinson P A A) LOBBYIST DISCLOSURE: (Required) B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). Flat rate $25 000 paid to Grav Robinson, P.A. 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: present lorbaendina award fartaoods eauipm nt or service? ~ ment or services or on a 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": oyes ~ No Are you lobbvina on a oendino aoolication for a Develovment Agreement with the City or I-cation for chance of zoning maa desionatton or chance to the Citv's Future Land Use 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 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., 0 Yes No: Are ou re resentin a not-for- rofit cor oration or enti without s ecial com ensation or reimbursement. . y, 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 SHALL/BE,FILED LVEIV IF THERE HAVE BEENONOTHXP NDITURES OR COMPENSAT ONADURING THE REPORTING PERIOD. ~ n Signature of Lobbyist I do solemnly swear that all of the foregoing fa 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. i1 ~ n ~ Signature of Lobbyist: Signature of Principal/C~eht: VI. LDBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: 0 Produced ID O Produced ID Form of Identification ~~ ~ 'VO , ~7 Personally known (Lobbyist) ~ , ~ ';~ VII. SIGNATURE AND STAMP OF NOTARY: m ~ ~ State of Florida, County of Miami-Dade , p subscrib d befor e t n ~cmq r~ Z~ p o' ^ap Swom T is _SI~-day Q ~ ~ ~ ~ of Florida t f e a Signature of Pu c Notary :~ ° ~ Notarization of Lobbyists signature o~ Form of Identification t~ersonally known (Principal) TEn/i/~SE~` -KrJG State ofa, County of Swom and subscribed before me This, y of Jj1N 0 ~~ ~YlZ •-~~ Signature of Public Not -State ofda Notarization of Princ al's signature ~pN C V,~ r oFrF.~ FPM v~ ~4qy.~.., ~ e~~C ~iin. .,.-. FOR CLERK'S USE ONLY Annual Registration fee: [ ]Yes [ J No Amount Paid MCR # Date Paid Lobbyist Registration Form received and verified by: Revised 12/D8/D4 F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYISr FORM 05.doc