Mark Cole/Miami City Ballet, Inc.m MIAMBEACH
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City of Miami Beach Office of the City2$~MAR -6 AM 8~ 55
1700 Convention Center Drive, Miami Beach, FL 3,~ 9
t,I~Y CLtr~~;`~ OFFECE
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.
Cole Mark
NAME OF LOBBYIST: (Last) (First) (M.I)
Miami City Ballet, Inc. 2200 Liberty Avenue, Miami Beach, FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-929-7000, ext. 1500 305-929-7002 markc@miamicityballet.org
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Mark Cole/ Miami City Ballet, Inc.
NAME OF PRINCIPAL/CLIENT:
Miami City Ballet, Irc. 2200 Liberty Avenue, Miami Beach, FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code)
305-929-7000 305-929-7002 markc@miamicityballet.org
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: Pamela N. Gardiner
Executive Director
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: NSA
II. SPECIFIC LOBBY ISSUE:
Grant application to City of Miami Beach Cultural Affairs Program
Issue to be lobbied (Describe in detail):
Tourism and Cultural Development (Cultural Anchors)
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
Miami Beach Cultural Affairs
ounce gem er
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
F~.4 "'RATE OR OTHERj.
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":
^ Yes X] No: Are you lobbying on a present or pending bid for goods, equipment or services, or on a
Dfesent 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~No: Are you lobbying on a Dendina application for a Development Agreement with the Ciri or
application for change of zoning map designation or change to the Ciri's Future Land Use
MaD?
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..
~7 Yes ^ No: Are you representing anot-for-profit corporation or entiri 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. w
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Signatur 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 Miami Beach City Code and all reporting
requirements. ~ n ~ ~ /~
Signature of Lobbyist: ~-
Signature of Principal/Client: ~ ~ C /J
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTI CATION:
Produced ID ~ Produced ID
/ Form of Identification Form of Identification
?~ Personally known (Lobbyist) ~rsonally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Da
Sworn to and subscribed efore me
This ~_day of ~~ ,
Signature of P lic Notary -State of
Notarization of Lobbyist's signature
~~~ ~ unty of Miami-Dade
iNobrr Ps1iBr s s ed before me
1~rCa~m 20~~
CMIROf~011 >Z 00
~~ otary -State of Florida
otarizat~on o incipal's signature
FOR CLE K'S U E ONLY
Annual Registration fee: [ ]Yes [ J No Amount aid MCR # Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05. ~/( Revised 12/08/04
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