Harold Cobb/Euclid East Condominium03/18/2008 15:13 3052671556 DAMS ENGINEERS PA PAGE 08109
m MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIS'T' REGISTRATION FORM
Lobbyist means all persons employed or retained, whether peld or not, by a principal who seeks to encourage the passage, defeat
or modificatipn of any ordinance, resolution, action or derision of any commissioner; any action, decision, recommendation of the
Cry Manager or any city board or committee; or any action, decision or recommendation of any city personnel during thQ time
period of the en[Ire declslon-making process on such action, declslon 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 en~gea
In Ipbbyinq activities. The term 'Lobbyists" hds 9pecifit exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST: (Last) (First) (M.I)"
..~
BUSINESS NAME AND ADD SS (Number and Street) (CIN) (State) (zip Code)
3DS= ~Co ~~~Cv .ADS ~to'1- 15'~o s~feT~~~c~yisen~(5. c~nr~
TELEPHONE NUMBER: FAX NUMBER: MAIL.
/I. LOBBYI57 RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
C ~ ~' [,.~ ~/fiJ ~ l G ~~J ~. /N~ ~r. ~S ~S C ~+ C~.~ ~ u t. /~1.~ . F~• ~~I.3 f
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (gyp Code)
~OS- S3d /!/3 ~a.1'• S3~- /io3 ~o~irN,< AIS~-/I`a(.....a,.,p~.~t•.~j c..ti
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-4B2 (c)]
• NAME OF CHIEF OFFICER, PnARTNER, OR BENEFICIARY:
l~a2C~(o Pd Nf.v~a ~ ~/"fl.e~/eu~
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5°Vo OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: ~~.
II. SPECIFIC L08BY ISSUE:
t~(cul S~S~e~m +~~efllar`cPm_ en~C
Issue to be lobbied escribe in detail):
III. CITY AGENCIES/iNDIVi0UAL5 TO BE LOBBIED:
Ind p
1nA~
~c~il~n
ra;l~q
v..lr •... . ~
Ano~~~A-~-s~~ ~~-8~--~. ~-~~
A) Full Nance of Individual/Title B) Any Financial, Familial or Professional Relationship
!~-~5-~or~ c ese.~vQ 'oh ~o~d N one
~-)
r-
~%
Q
T
'T'I .~
n
i~
D
7 s~~
' /
~ ~~
;~
03/18/2008 15:13 3052671556 DAMS ENGINEERS PA PAGE 09/09
.~ _ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOlJRLY,
Ful T RATE OR DTHER). ,
A) LOBBYIST DISCLOSURE: (Required) i ~. U_~p~ ~ +~~
6) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ~t..~
The following information must be answered:
~ Naar
1) Pursuant Co Miami Beach Clry Code Section 2-488 Entitled "Prohib+ted Camps+a~ r_rintri6~tions By Lobbyists
On Procurement issues":
a~~Q~1re vo lobbvina a present or oendina bi for Goods eQUipment or services or on a
Ares nt or Den Ina award fo ooods• ea i m4nt or service?
2) Pursuant to Miami f3each Clty Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
~;r ~lo Are you lobbvina on a Den inq•appllcation for a Develo ment Agree nt with the~~y or
aDDllcation for chance of z9ning maD designation or cb nee to the C'ty's Futur_e_Lend Use
MaDi-
3) Pursuant to Miami Beach Gry 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
5¢ction but, shall not be required to pay any registration fee5._
~~~~No• Are you reoresent'na a not-fior-Drofit corporation or entity without special oomDensaSlQn
or imbur9ement. .
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.
Signature of 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 z-462 of the Miami 9each City Code and all reporting
requirements.
Signature of Robbyist:
Signature of Principal/C
VI. LOBBYIST IDENTIFICATION:
:. Produced ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP
State of Florida, County of Miami-Dad '"I
Sworn to nd subscribed before~me
"„~
This ~~ day of /~~1 . 20
Signature of Public Notary -State of Florida
Notarization of lobbyist's signature
PRINCIPAL IDENTIFICATION:
Produced ID ~•. (~V?~1~5 CQ.1'15Q
Form of Identification
Personally known (Principal)
• ,XlL1E L BLMICO "' JULIE L BLAN00
_~ ~'~;~ MY COMMISSION # DD 588494
MY COMMISSION # DD 588494
EXPIRES:Oc-ot>~~o a, County of Miami-Dd EXPIRES; October 20, 2010
a,„d,an,~uwoanP u ~ scribe b_e`f~e me . rttt5' ~naat~mrkunPubMcuneawdw.
is day of /~D111. ~ 20
I~jgK'>a ure of Pubiic Notary -State of Florida
Notarization of Principal's signature
FOR CIERK_S11SE ONLY p, P D
Annual Registration fee: [ ]Yes [ ] No Amount Peid _T~, O M ~ ! ~ J Date Pald ~ D
Lobbyist Registration Form received and verifietl by:
F:\CLER\;ALUMARIA-M\Lobbyist\LOBBVIST FORM 05.doc ` Revised 12/06/04
m
City of Miami Beach, 1700 Convention Center Drive, Miami beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fax: 305.673.7254
CityClerk@miami beachfl.gov
LOBBYIST NAME: d~~ , ~~,
I understand that no later than October 1st of eoth 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.
i c=_,iU2 ~~YI ~'' t -l ~ 1'~ tit 2c~ o ~'
Signature: Date:
:tCiw 1~1L.C11~1~1Ti1~of~y€s4 registrtiarr F'orsrs 3_ ' .~ ~ .,