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Jeffrey S. Bass/Richard A. Freeman, Esq.~~~, ~ ; i ~ . b+., d / 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, tN 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. NAME OF LOBBYIST: (Last) (First) ~ lM•~) .~ub+e~ ~ IbCJ~, ('.%~. ~'~P ~•W. I-t•,~ ~-I.tG(rt~ Z ._33) 30 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (tip Code) 3G~ ~ 3~t - Cot,XvU G~Us) '~'• ~ ~~~;~ ~J1cz~~~~ ~ntllanl~i ~~ r~~- TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: +).~ rc.ZSl ~C~ NAME OF PRINCIPAL/CLIENT: ~~ ~IA~z.U i,.t.-Z., i(~i t,.~~~r~i~• ;a~~. ~e-~~~ (~Uar"~; t^~. ,33r3`~ BUSINESS NAME AND ADDRESS (Number and Street) (City) ` f (State) (Zip Code) { xf~S" j ''1 °~ ~1 ~~ t7 1 ~,j ~ TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2482 (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: u.SPECIFIC LOBBY ISSUE: be lobbied ~~ '.i i r,~~ 1.A _Lrr '• c `1. ., r ul. CITY AGENCIES/INDNIDUALS TO"BE LOBBIED: (Pursuant to city code section 2-4s2(g> c 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(a)(4) 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) 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) ~ ~,SO • ~ ?~ ~~N B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (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": ^ Yes 1.1d'No• Are you lobbvinq on a present or pendinq bid for goods equipment or services or on a present or pendinq 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 I~ No• Are you lobbvinq on a pendinq application for a Development Agreement with the City or 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: ST I do solemnly swear that all of the foregoing facts are provisions contained in Section 2-482 of the Miami Bea Signature of Lobbyist: Signature of Principal/Cli t: VI. LOBBYIST IDEN FIC ^ Produced ID Form of Identification N ~ ~ ~ Personally known (Lobbyist) W p N o 4' m VII. SIGNATURE AND STAMP OF NOTARY: ~' z ~ ~ e State of Florida, County of Miami-Dade ~ X ~ Sworn to and subscribed efore me ~ "' ° This day of ~c riy , 2008 s~et~ b~ `•,. Signature of Public Not - Sta of Florida oti ~,p` Notarization of Lobby~t's signature ~c6fFect and that I hie read or am familiar with the Code and all reporting requirements. PRINCIPAL I ENTIFICATION: t/ ^ ProducedlD Form of Identification m~act ~" ~"nu~ ~ Personally known (Pri ipal) ~~~~~~~ ~q 201PR..pVBli~, N. GONZ~4I.EZ * * MY COMMISSION # DD 444177 EXPIRES: June 26,2009 State of Florida, County of Miami- F~o~-~°e BondedThruBudgetNotaryServir. Sworn and subscribed before me This day of V12. , 2008 ~~ ~ , Signature of Public o ary - 6tate of Florida Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes [ ] No Amount Paid $ ~ r MCR - Date Paid ~ Lobbyist Registration Form received and verified by: F:~CLER~LOBBYIST\Lobbyest Registration Form 32708.doc Revised 03/27/2008 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): 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 ©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? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^ Yes ^ No: Are you lobbvinq on a pending application for a Development Agreement with the City or 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. ^ Yes ©No: Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. . ~ V. SIGNATURE UNDER OATH: ON OCTOBER 1sT OF EACH YI STATEMENT UNDER OATH, LIST IN THE CITY OF MIAMI BEACH F EVEN IF THERE HAVE BEEN NO I do solemnly swear that all of the provisions contained in Section Signature of Lobbyist: Signature of Principal/ li VI. LOBBYIST IDE -ect that I have read or am familiar with the and reporting requirements. N: /PRINCIPAL IDENTIFICATION: ,lf'roduced ID Form of Identification Personally known (Lobbyist) ~ b ~ ~ ~ Vil. SIGNATURE AND STAMP OF NOTARY: G N Z ~ = ~' ~ State of Florida, County of Miami-Dade Sworn to d subscribed before me Thi d 2008 f ~1 r~ ~ ~ z ~ a s ay o -f , u - ~ to ~ ` ;,l_u`Y <~ ~ * `° Signature of Pu is N ary - ate of Florida °4~ "%ao Notarization of Lobbyist's signature a r• w ~~ * 9~'~ ~ Produced ID Form of Identification ^ Personally known (Principal) State of Florida, County of Miami-Dade Swom and subscribed before me This day of , 2008 Signature of Public Notary -State of Florida Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ j Yes [ j No Amount Paid $ MCR # Date Paid Lobbyist: Registration'. Form received and verified by: F¢\CI»ER\LOBr3YxST~Lobbyist Registration farm 327O8.doc RevisedD3f 27/2008 `~ City of Miami Bench, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Tel: 305.673.7411 ,Fax: 305.673.7254 CityClerk@miami beachfl.gov LOBBYIST NAME: ~~~-(•-~r~~a ,j ~(.~s~> 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 j Lobbyist Expenditure Form 2) Disclosure Form Failure to file these for son tim y basis will result in my name being transmitted to the Miami-Dade County mm' s'on Ethics and for code violation evaluation. In addition, one can is u~ I ave~r•egistered to lobby on has been resolved, I am required to immediately o~ify t ~ Ci C~-~~ffice of lobbyist withdrawal in writing. ignature: Date: F:ICLER1LaBBYl57lLobbyist Registration Form 32708.doc