Nic Ward/Fisher Island Holdings, LLCk~mi Bcach
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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 engaged
in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
NIC WARD
NAME OF LOBBYIST: (Last) (First) (M.I)
Designed Flood Protection, Inc. 2829~~ird Avenue, Suite 5, cmb311, Miami, FL 33133
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
786-239.7773 305-774.7048
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Fisher Island Holdings, LLC
NAME OF PRINCIPAL/CLIENT:
One Fisher Island Drive Fisher Island, FL 33109
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code)
(305) 938-2944
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
Robert Sosa, President
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Floodplain Management appeal and other administrative appeals regarding Palazzo del Sol and del Luna
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
Board of Adjustment
Design Review Board, Planning Board
B) Any Financial, Familial or Professional Relationship
City Commission
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf p
A)* LOBBYIST DISCLOSURE: (Required) $ ~ O C- Ch-2.~ ~ ~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $
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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 pending bid for aoods eauiument or services or on a
present or pending award for aoods eauiument 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 pending application for a Development Agreement with the Citv or
application for chance of zoning map designation or chance 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 fi~NO' 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 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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Sig o 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:
VI. L BBY IDENTI CATIO
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1 ~ Produced ID~1~ V ts4 a oUba y l33 8c~oo ~
Form of Identification
^ Personally known (Lobbyist)
SIGNATURE AND STAMP OF NOTARY:
of Florida, County of Miami-Dade
and subscribe befor e
day of~ 20~
PRINCIPAL 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_
of Public Notary -State of Florida Signature of Public Notary -State of Florida
:ion of Lobbyist's signature Notarization of Principal's signature
FOR CL (~ USE ONLY
Annual Registration fee: ]Yes [ ] No Amount P~ai MCR # Date Paid
Lobbyist Registration Form received and verified by: ~ II^^
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc l~ . Revised 12/08/04
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
fLAT RATE OR OTHERt p
A) LOBBYIST DISCLOSURE: (Required) $ ~ ~ C'~ ` ~-~~ N ~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
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":
Q Yes C~NO' Are you lobbvina on a present or pending bid for goods equipment or services or on a
gre~pnt or pending award for Qoods equipment or service
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes IO NO' Are you lobbvina on a pending application for a Development Agreement with the City or
application for chance of zoning map designation 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 definitlon of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of gnat-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 dNo• Are you representing gnat-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 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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Sig o 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:
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Signature of Principal/Client: /
VI. L BBY IDENTI CATIO
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~ • „~,~ Form of Identification
Y
^ Personally known (Lobbyist)
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I. SIGNATURE AND STAMP OF NOTARY:
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~ ~ ~ ~; to of Florida, County of Miami-Dade
~ ~~ ~ ~ , o and subscribe befor e
`" ~ is day of r 20~
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i na a of Publ c Notary -State of Florida
ation of Lobbyist`s signature
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
~ / pUBI.TC-STATE OF FT,O?~A
!,`,~ Personally known (Principal) ~"'~ Ca~anne ~ Co!onI«~e
Commission #T3D725232
~~` Expires: J~-N. 2~5~ ~
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State of Florida, County of Miami-Dade
Swam ubscribed befor me
This ay of ~IQ,Ir~20~~
Signatixce'of Public Notary - 51`ate of Florida
Notarization of Principal's signature
FOR CLERK'S USE ONLY i~ ~1 QG 0 tS
Annual Registration fee: ( ]Yes [ ] No Amount Paid ~- MCR # l Date Paid ~/
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc Revi d 12/08/04
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