George Green/Holland Watters - Johnson Controls, Inc.m J~IAMIBEACH
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.
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NAME OF LOBBYIST: (Last) (First) r (M.I)
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BUSINESS NAME AND ADDRESS (Number and Street) (City)
TELEPHONE NUMBER. FAX NUMBER: ~ EMAIL:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CLIENT:
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INESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
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III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-482(g)
include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise to an
appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2-
482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the
commencement of service of City personnel to be lobbied.)
A Full Name of Individual Title B) An Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)- ~ Q.V `f
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B) PRINCIPA ' S S! 1 ~QF L ~jY.IST C qE ATION) , ~
(Required). ~~ ~ ~ \ J I ( i. ~ ,~~ f~ fV l: y
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":
l~" Yes ^ No: Are you lobbvinq on a present or pending bid for goods, equipment or services, or on a
present or pending 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 L'l No: Are you lobbvinq on a pending application for a Development Agreement with the City or
application for change of zoning map designation or change 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 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 Ll No: Are you representing snot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
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„(3each City Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
^ Produced ID
NOTARY PUBLIC-STATE OF FLORIDA Form of Identification
•""' ,~ Marion Gait Bos
?, Commission# '0963 ally known (Lobbyist)
• Expires: 5E
BONDED THRU ATLA.'VTIC BONDING CO., INC.
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before Jae
~~his J Ff day of ~~' +! , 2008
S~nature of Public Notary -State of Florida
N tarization of Lobbyist's signature
~ Produced ID
Form of Identification
,,_-....,, // ..,,T, rv ^;..", ;CSTATE OF FLORIDA
L`}'Personally known (Principal) .,; ~ ,~~aTiOnGali BOSSC
'`,^, } ~ Cnmmission #DD710963
'~~ ~~i~; ~xnires: SEP.10, 2011
•, I LtU ~:1::U ATI,ANIIC BONDING CD., INC.
State of Florida, County of Miami-C~'ade
Sworn and subscribe befor~ me
T i I `~ day of r ~ , 2001 C?~-A-~
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Sign ture of Public Notary -State of Florida
Nota ization of Principal's signature
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~ •~ Sign~'ture of LobUyls~
m MIAMIBEACH
City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk~miamibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: f~"~~ ~'~-~ r ~ = ~-°~ ~'~'~ ~
,.
I understand that no later than October 1st of each year, I must file the following
forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
1 ~ Lobbyist Expenditure Form
2) Disclosure Form
Failure to file these forms on a timely basis will result in my name being transmitted to the
Miami-Dade County Commission on Ethics and for code violation evaluation.
In addition, once an issue I have registered to lobby on has been resolved, I am required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
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Signatur .
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Date:
F:\CLER\LOBBYIST\Lobbyist Registration Form 32708.doc
Page 1 of 1
Prieto, Silvia
From: Hatfield, Liliam
Sent: Tuesday, April 15, 2008 1:39 PM
To: Parcher, Robert; Prieto, Silvia
Subject: Lobbyists fee disclosure given by phone
R7D Nanc Ashman Sala Bonus
Geor e Green Sala Bonus
Alfredo L. Gonzalez $325 er hour
Trac Walker $285 er hour
Juan Carlos Bermudez $325 er hour
L3~3.~m
MIAMIBEACH
Liliam Hatfield, Office Associate V
CITY CLERK'S OFFICE
1700 Convention Center Drive, Miami Beach, FL 33139
Tel: 305-673-7411/ Fax: 305-673-7254 / www.miamibeachfl.pov
We are committed to providing exceNent public service and safety to all who live, work and play in our vibrant, tropical, historic community.
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