Robert L. Switkes/SMGA
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City of Miami Beach Office of the City Clerk ~~, c
1700 Convention Center Drive, Miami Beach, FL 33139 ~, ' ,MM
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LOBBYIST REGISTRATION FORM ~ ~ ~
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Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, d at cx~nodif~on of
arty ordinance, resolution, action or decision of any commissioner, any action, decision, recommendation of the City Manag~or city rd or
committee; or any action, decision or recommendation of any city personnel during the time period of the entire decision-malpf~g prtlcess such
action, decision or recommendation that foreseeably will be heard or reviewed by the city commission, or a city board or~n mtftdE. The term
speci6caly includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has stxcifi~cclJ~ns. Please
refer W Ordinance 2004.3435.
- L V .. ~ _ ~
~-./l ~ \ T ~ 1C~ 1_ CAL J[ Y 1-L~Y ~. ~
NAME OF LOBBYIST: (Last) (First) (M.I)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LL~O.,B~BYIST RETAINED BY:
~<<1~ _ ,
NAME OF PRINCIPAUCLIENT:
BU INESS ME AND ADDRESS .(Number and Street) (Cit ). (State) (Zip Code)
TELEPHONE NUMBER: FAX MBER: (Optional) EMAIL: (Optional)
Fill out this section ifprincipal is a Corporation, Partnership or Trust [Section 2-482 (c))
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
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• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
u.SPECIFIC LOBBY ISSUE:
Issue to be lobbed (Describe in?I'etaiq:
ul. 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(ax4) 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 OTHERJ:
A) _ OBBYIST DISC SURE: Required)
B) PRINCIPAL'S DISCLOSUR (OF LOBBYIST COMPENSATION): '-~~ 4 Z-OC~By
(Required).] ~
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 288 Entitled "Prohibited Campaign Contributions By Lobbyists
,_, On Procurement Issues":
L"J Yes ^ No: Are ou lobb in on a resent or endin bid for oods a ui me
present or oending award for goods equipment or services nt er services or on a
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
R~ea~l Estate Development Issues":
Yes L~' No: Are ou lobb in on a endin a lication for a Develo ment A regiment w'
a lication for chap a of zonin ma desi nation or chap a to the Ci 's Future Lan eor
Maa?
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
s~ect~ion but, shall not be required to pay any registration fees.
Yes LJ'No: Are ou re resentin a not-for- rofit cor ora
~ teen •r entity without special compensation or
reimbursement
V• SIGNATURE UNDER OATH:
-----• •••~• ~-~~ ~~ ~~•~ ~~~~mg ra is are true and correct and that I have read or am familiar with the
provisions contained in Section 2-48 of mi Beach C' ode and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client: D' ,~
~• LOBBYIST IDENTIFICATION; PRINCIPAL IDENTIFICATION:
^ ,Produced ID ~ Produced ID
Form of Identification Form of Identification
U Personally known (Lobbyist) L~ Personally known Princi al
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~I• SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Swom and subscribed before me State of Florida, County of Miami-Dade
This da ofj ~~~ Sworn d subscri ed bef re me
,.N,.. ...Y...NIei~~~r~liWS+ This i~1(.A ....
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Signat r is N t - FI rida Signat r 'c N
Nota~ ob ~ na u~ Notari ~ ri ~s~~~`pppp-l ida
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TO BE COMPLETED BY CITY CLERK'SrS~'ASNLY
Annual Registration fee: [ j Yes ( j No Amount Paid 3 MCR #
Lobbyist Registration Form received and verified by: Date Paid
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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
LOBBYIST NAME: __ ~~' ;~~ .~,, ~,'=~(~~
I understand that no later than October 1st of each ,~Cear, 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.
~~~~0~
Signature: Date:
R~;vi~ed o~,c?~2o;7r
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