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Kent Harrison Robbins/Hugo Cleaning Services, Inc.m M~ann~BEACH 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 princpal as well as any employee engaged in lobbying activities. The term "Lobbyi~ ha¢ specific exclusions. Please refer to Ordinance 2004-3435. ~s NAME (M.I) BUSINESS NAME AND ADDRESS ~ (Number and Street) (City) (Stat~j (Zip Code) 305 -- 532 -OSoo y 3oS-S 3l --olsy:; ~G~trv,66i~s r~ kcl~~ I. LOBBYIST RETAINED BY: ~~. NAME OF~INCIPAL/CLIENT: V ' ~L ` ~ a~ A11~13 7 ~ v~ , ~Q m, 331 ~ BUSINE S NAME AND ADDRESS (Number and St et) (City) (State) (Zp Code) TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP R TRUST: ler~ro ~~ peftr-" ~ 1 ~.~.j. Ca r rn~~a ~i ~o~~o~y ~ ~ lay. II. SPECIFIC LOBBY ISSUE: t-~i2~+~~~~~ ~ / rj to III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title 8) Any Financial, Familial or Professional Relationship ~rtifGUPGh~Gh T M p hR C1n~n ~ Q ~ ~, ~4ha ~s d~ Lc m on ~ ~ C • me d h t .~ ~~ ~.~ ~, _~. \./~ ~ ~ '~ fV IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHERf A) LOBBYIST DISCLOSURE: (Required) B) PRINCIPAL'S DISCLOSURE (OF LOBBY 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": 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": 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 EXPEN ITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE P CEDING CALENDAR A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN DITUiR~{~'R COM SA ~ DURING THE REPORTING PERIOD. / / )'/ nature of LoblSyist I do solemnly swear that all of familiar with the provisions ont requirements. Signature of Lobbyist: Signature of Principal/Client: ~ VI. LOBBYIST IDENTIFICATIOI VII. in facts e e and correct and that I have read or am of e,~Miami Beach City Code and all reporting PRINCIPAL IDENTIFICATION: jl Produced ~~~L ~~'eQ- 47g - ~9--~jltfr~j_p Form of Identification State of Sworn subscribes fore me This day of , 20(~r ignature of Pu is - -fate of orida Notarization of Lobbyists signature Personally known (P cy~ '•• r. Rwc~rn ar+vF :° ~;: Notary f'ubIIC - StafQ Ar DD 376468 State of Florida, Count Sworn and subscrib ore me This 1~~laye~f 2 Signature of Public Notary' Stafe~erf F1br Notarization of Principal's signature FOR CLERK'S USE ONLY ~ Annual Registration fee: [ ]Yes [ ] No Amount Paid 1~ MCR #~ ~ ~~ - Date Paid •~ ~® ~~ Lobbyist Registration Form received and verified t-y: ~ - , F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc ^"zi<- ..~7.~`~-% Revised 12/08/04 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 sec~{pn but, shall not be required to pay any registration fees.. Prnriurari Tf) This matter relates to a disqualification protest matter (Miami Beach RFP No. 04-07/08). If you require further details, please let me know. Marie Jorczak Legal Assistant to Kent Harrison Robbins 1224 Washington Avenue Miami Beach, Florida 33139 Telephone: (305) 532-0500 Facsimile: (305) 531-0150 Silvia Prieto, Administrative Aide I CITY CLERK'S OFFICE 1700 Convention Center Drive, Miami Beach, FL 33139 Phone: 305-673-7000 ext. 6269 / Fax: 305-673-7254 www. miamibeachfl.gov We are committed to providing excellent pub/ic service and safety to all who live. work and play in our vibrant, tropical, historic community. From: Hatfield, Liliam Sent: Wednesday, February 20, 2008 4:24 PM To: Prieto, Silvia Cc: Martinez, Maria Subject: Lobbyist Kent Harrison Robbins Silvia, Under item, RFP 04-07/08 should be entered instead of Pedro "Peter" etc... Also, change "genitorial" for "Janitorial" Thanks.