Joseph Goldstein/Amerescom N1IAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means aU persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat or modification of
any ordinance, resdution, aetbn or deasion of any commissioner; any action, decision, recommendation of the Clty Manager or any city board or
committee; or any action, decision or recommendation of any city personnel during the Ume 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 tens
specifically includes Uie principal as well as any employee engaged in lobbying ecUvkies. The term "Lobbyists" 'has specific exclusions. Please
1-efer to Ordinance 20043436.
GOLDSTEIN JOSEPH Nt_
NAME OF LOBBYIST: (Last) (First) (M.I)
Shutts & Bowen LLP 200 E. Broward Blvd. Suite 2100, Fort Lauderdale FL 33301
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(954) 847-3837 (954) 888-306h ieoldste~n(~sh~ttc_cnm
TELEPHONE NUMBER: FAX NUMBER: EMAIL.
LOBBYIST RETAINED BY:
AMERESCO, INC.
NAME OF PRINCIPAL/CLIENT:
5200 77 Center Drive Suite 300 Charlotte N(' ~R~17
BUSINESS 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:
George P. Sakellaris, President/CEO
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INQIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST: Privately owned.
II.SPECIFIC LOBBY ISSUE:
~ ~~ ~"v~~
Cit of Miami Beach~En~r Servi " Project")
Issue to be lobbied (Describe in dotal
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-4s2(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 Clty personnel sought to be lobbied; further, pursuant to Clty Code Section 2-
482(a)(4) include a statement of any cohtractual 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 Relatlonshi
Ma or and•Cit Commissioners None.
City Boards ~ Committees,
City Administration, to the extent
ermissible.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
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":
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":
application for change of zoning map designation or change 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 snot-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.
reimbursement. .
V. SIGNATURE UNDER OATH:
~~~~~1/~
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 2-482 of the Mi i Beac C_it~Cod/e and all reporting requirements.
Signature of Lobbyist: ~ •~~~~~" v
Signature of Principal/Client: ~
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
IDENTIFICATION:
~~~~
L%( Produced ID ~I art dy1 ~vCrS ~ (.~n~
Form of Identification
Personally know Personally known (Principal)
.~"~y""' KAREN L ROBINSON
'~'~ ~ ~'p ~' ~pIJ~QM # DD 579768
VII. SIGNATURE A $ ._7 ~ NOTARY p[)g~~y~A~OFFLORIDA
%~~. ~ f EXP R S: August 31,2010 ~~ ,.
"~f ' ' BmdW Thru NWery Public UnderwrMers Lnur~n M. Marks
State of Florida, County - ate of Florida, County of Miami-Dade~~~~~ ~DD755Sg1
Sworn to nd subscribe befogg me Sworn and subscribed before me ~~„,~ ~pjt.~; ~~_ 05.201
This~da of L. , 2008 This ~f~day of >; ~ , 2008 soNpgp~p~~caoxpINa~,~~G
Sig ture of Public Nota -State of Florida ignature of Public Notary -State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
/ TO BE COMPLETED BY
Annual Registration fee: [ ]Yes [ ] No Amount Paid ~
Lobbyist Registration Form received and verified by:
F:\CLER\LOBBYS5T\Lobbyist Registration Farm 32~Oi3.dac
~C//1 Date Paid .
Revised
m
City of Miami Beach, 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
(~, ~n I e
LOBBYIST NAME: ~~s~~' J +r '- ~`~~y ~~~ ~
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.
Signature: Date:
F:ICLERILOBi3Y1ST1Lobbyist Registration Farm 32708.doc