Robert Goodman/John Casagrandef ~ ~ dnt ~ Y
F~~i/ ~,t \ it
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.
~J~'~G~
OF LOBBYIST: (Last) (First) (M.I)
uirc~o sinner nnin nnnoCCC / 6,.,, F,or ten!! Ctroof\ !(:itvl IStafal (ZiD
LOBBYIST RETAINED BY:
W
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: -1 °o
ao
u.SPECIFIC LOBBY ISSUE: ~- ~ '~
Issue to be lobbied (Describe in detail): ~ ,, -rJ
~ ~
ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to Ciry Code se~~on ~82(g~
include a statement of the extent of any business, financial, familial, professional or other relationship, giviflg rai~to a~
appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Codl: Sl~yon 2-
482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the
commencement of service of City person~iel to be lobbied.)
A Full Name of Individual Title B) Any Financial, Familial or Professional Relationship
/ /
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). SAME AS AL3bvE
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 DC1 No: Are you lobbying on a present or pending bid for goods, equipment or services, or on a
-~
present or pending award for goods, equipment or service?
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 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.
reimbursement. .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
jr Signature of Principal/Client:
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VI. LOBBYIST IDENTIFICATION:
Produced ID~,( ~~f'%y~.'/~ ~iCC`_'175~
r Form of Identification
G . X5.5 -'7'77- 3 ~--.~G_ ~-- C
^ Personally known (Lobbyist)
PRINCIPAL IDENTIFICATION:
0 Produced ID
Form of Identification
^ Personally known (Principal)
SIGNATURE AND STAMP OF NOTARY:
ate of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
worn to a subscribe before me Sworn and subscribed before me
his y of , 2008 This day of , 2008
Si natur f Public Notary -State of Florida Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY , , _ _
Annual Registration fee: [ ]Yes [ ] No Amount Paid $ MCR #
Lobbyist Registration Form received and verified by:
~ : }~L~FZ1~Ca~3}3'Y' ~B ~t a[at2yi~t ~e~6stra~ittn Saar sa ~2?~$.acr~'
Paid
Revised 03/27/2008
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
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 Sect 2; ~t82 of the M~rrai'Beach City Code and all reporting requirements.
IV. UISl:LUSUIiE OF T L-RMS ANU AMUUN t8 OF LUfiFlY1;;1 CUMI'FNSATION (DISCLO5~ WHl~ tHFR HOI1Rt Y, ~l_AT
AATF OR (?TMFRJ:
~`,i t~,Ut. ~'I T iJ15CLO5Uf L: (Iic~uiracO /~~~ ~ ~ ~,, /- n ~'
~': F'I II ~:I~'AL'S UtSCLU~~Uf:;E (VI" LCJL+ISYIJT COt.1PEN.'3ATI~~N}
(Kerr,ulrr~tli. SAME. _~~ __AL3b_Y_~.._~ _
Thn iallawin~ information mull be answered-
1 ] ('ur~urant to Miami 13ra~•h City CoJc 3cCtic+n 2-4H8 G-ntitterl "F'rol'iik+i!eJ Carnpi,ign Cantrlt,utinnr Cq I_r~i;f;yi~~ts
C)n F'roourement Issues°:
Yu, ' Na: AfH~UU Iat~tying•on a present or polndin_y bid for Goods, Hoc uipn_ront ar ar_rvicEts, or on a
present or-penrJinq ;)warrJ fc+r ryoods, Cnuipmanl r+r ~:r~rvlce? - l~^-_
F~uru~mt to tvliAcni [3i~ar;r City Codes 2-4£+0 [ntitlr~d "F`rofrit+itcd C~mpairln Contributions 13y I obhyi~,ts C)n
Rc21 [-stele drwr_loprnt:lnt Iss,.rer;".
Yc ; ,?( No: Are you It~tlhyinr~nn a pendinct at,plication for a DevHlopm~_nt_Agreemcnt with the^City ar
__ ___
~ ,ryppliC7tion for chanc3r' at zoning m,rp rlcs_ignation or chn~r to the City'tt Futurr_land Usc
Mme- _ .
Ji I~Ur^.li8nt tb (1~i7~rf+i (jf.'.dr,ll City t.odr.• ?-~liti,1 (I I} furl`,( IiC•f'..r!n lh~f:C~'(it 1110':0 CXr.•'71~!t frf_rrfi (hri rjr`initinn rr(
"ioLbyist" as set forth in `e.Uvrr 7 ~1~,1 ahir}vr_) ta~ho on!~ ;,C(~~:'ri+ + ar. a representativ~~ u( .'. r,r,t-'nr-prr.,fit
corporation or entity vrithaut ;~f,rlCf;n1 Com('+e~nsation or mlmlit,rP;r~rnr_,nt far the appr_.:r:tn~C~, wl•c1h~•i !':irCri, ur
indirect, to express support of or oppasilic~n to any item, .^,hall rrrti~ter ,pith the r_Ic:rk, as r,rt,,IlrC•r, ray this:
r•eCtion but, sh~il not hua n3quireCl to pay any regi~,tr3tlon fees.
Yas ;~ N
reimbursement. .
inn or
v. SIGNATURE UNUEIl UAI tl:
ON OCTODER 1sT OF CAGH YEAR, EA
S1 AI tMtNT UNDER OATH, l I ;~fING LO[
IN I Ht 011 Y OF MIAMI E3F=ACH F_OR I HE
EVEN IF -THERE hIAVE f3GCN td0 F.XI'END
U I 51J,L'PJIIT TO THE CIfY CLGRK A_51GNED
_RC`;~AS WELL AS CQMI'ENSATfON_R_ FCt=1V
NDAR_YtAR. A STATEMENT SI~IA1.1 RE FILED
NSA~fIrJN DUr~NG THf=_Ktl'ORTING r~FFtIOD.
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of Lobhvist - -- - -
I c'c~~ °•c~lr-ir,l~iy swear that aft of the toreceinq facts .are true 2nd cc~+rrer,.t :~nrJ th:~k I brave road or ani I..,iniliar .pith thr~
prr;~.nrJO'~ ~ c~inl~ined in Sr_,cai~ ~;4N2 rt thC~ ~rl~;~rtll'l;eoCh Cily Ccidr~ .')nd ~:il r~lx+rliny rerJilirernr~,nts.
~,rtn.-,turr• of I_nbbyist:
--- ---:>!gnLtturc Of Principal/CIiF(nt:
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VI. I.ORFiYIST IUtNTIFIC
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~y l~rcxluced I[_lt~.LU11'~J5-_ ,~~~.~,~(
hone of Irir~ntif cation
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;_ P~ir.,onailly known (I_otlt)yi~st)
VU. ~IC:NAi'IIRE AND STAMN OF NOTAF~Y:
"•~t; ~t! • 0' I-larirlo, COUnIV Cif r~1laml-D%,d
,,.lnrrl to ;End subsoribed t}Fa(c}re me
fhiG daV of tJ0(t
.Sirtu..,tl~ri: pf I`ilbliC Notary - 51atc «r F!r+ric~a
Notarization vt Lobbyict•.t siyn;ature
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TO CtL- COMPI,.t: t ED fiY CI IY Ct_ff~K'S STAfr UPILY
lennu,ll Ein~l*,h'atian it e: [ ] Yea C J Nr; Amuwtt Pair) ~ r MCf` JS . }_~ Date Palrl ~/
I rrht~ylxt Rngr. ErnUon 1=orm rncrwed and vrritied by:
f:;e:Lr.K'+r GE'RYl`~t'+LOlshyia. Krl(izCr;~tron Ir~rrn 717ftfi.dUC Rrviset7 03/»f1UUR~