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Hiram A. Ruiz/Rob Schuler - City's Security Contractm MIAMIBEACH City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, Fi.. 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, deasion or recommendation that foreseeably will be heard or reviewed by the aty commission, or a city board or committee. The term spedfically includes the principal a~ well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinanr;e 2004-3435. NAME OF LOBBYIST: ~~i V i.~v c A- ~ ~ r , 333 (-l 1 ~~ y~'~ ~ ~ ~ i1~t~3 ! Fc.~~ c cl p and Street) (City) iState) (Zip 3 vs - 6 ~-2- ~o ~-- ~3vS - 6 ~- Z - ~ s ~ 1 I-( (. y ~ ~. @ sc t ~ I (_ v~j TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: NAME OF PRINCIPAUCLIENT: S~"~ V (,uC,f+c- t t , 333 N t sr y~h ~~~, an.~ ; ~~ ~~~ - ~-~v BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 3 U ~- b ~1- Z - ~-c~ ~- (- 3 t~' -6 `~- t - ~ if e i (ZS min, v ~.~-~ ~ J~ t U 11 . a ~ j 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: • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5°k OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: u. SPEGI~IC LtaBBY.1SSUE. L' I-~ yes S ~. c v ~- ~ ~ ~~.. -~~K-~-~c~ Issue to be lobbied (Describe in detail): III. ct~r AGEr,~lES~~aorv~©ua~s Y~:~~ ~.t?-~~i~: A) Full Name of IndividuaUTitle B) Any Financial, Familial or I~rofessional Relationship rVtYVb l..S S t v !t Q rS t "a o L.. rr~$ Il/D N ~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DIliCLOSE WHETHER HOURLY, FLAT RATF OR OTHERj. A ~1j A) LOBBYIST DISCLOSURE: (Required) /" `a B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). Y O ~ U Q O o ~ X ~ ~ N ~ o ; ~ ~ ~ ~ Z w ~ x ,~ ~ a a ~ ~ X u W ~ } ~ ~ 4 ~e`~' Yg4o~ $ fi ~ The following information must be answered: 1) Pursuant to Miami Beach City Cade Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On~Procurement Issues": ^ Yes Flo: Are you lobbvina on a Dresent or Dendina bid for goods, eauiD€nent or services, or on a present or tzending 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": ^Yes lo: Are you lobbvina on a cendina aoDlication for a Develoument ~areement with the Cfir or application for chance of zoning map designation or chance 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 n~presentative of anot-for-profit corporation or entity without special compensation or reimbursement for thN appearance, whether direct, or indirect, to express support of or opposition to any item, shall register wih the clerk as required by this section but, shall not be required to pay any registration fees.. (XYes ^ 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 1'HE 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. Signature of Lobbyist I do solemnly swear that all of the foregoing facts are true and correct ~~nd 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/C VI. LOBBYIST IDENTIFICATION: Produced ID Form of Identification ~-Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Swo~~~,ditd SUbSCflbe IJ efor e This' ~1`.- day of ~~'~~~~0~ A~ Sig re Public Notary -State of Florida Notarization of LobbvisYs sinnature PRINCIPAL IDENTiFIC:ATION: ~~s ~b o S l ~ Produced ID ~ ~o~,~o~ Forni of Identification N Personally known (Principal) ~ 3 m ~ m ~ -n X U v~ c w ~ ~ m p 3 Crl ~in~~ ~ State of Florida, Count/ of Miami-Dade O ~' = ~ Sworn d subscribed before~me '~ '~ o c This ay of ~~~.20~ <~ ~ a ~ ~ , ~ ~ ~ Signature o P ary -State of Florida - - - ..------ - .....~....~........... ~ .......~. ~ ~.yuaw. c FOR CLERK' USE ONLY ^(~ -/`-'d Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # ~/'~ ~~ D e Paid Lobbyist Registration Form received and verified by: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc Revised 12/08/04