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David Coviello/Ocean Drive Improvement Association, Inc.Ml~,isJBEACH City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 L06BYIST 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: NAME OF LOBBYIST: (Last) (First) (M.L) Coviello David J. BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) Ocean Drive Improvement 760 Ocean Drive Miami Beach Florida 33139 Association, Inc. TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) (305) 531 - 4411 (305) 534-9080 marlo@goldmanproperties.com I. LOBBYIST RETAINED BY: NAME OF PRINCIPAL/CLIENT: Ocean Drive Improvement Association, Inc. BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) c/o Marlo Courtney 760 Ocean Drive Miami Beach, Florida 33139 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) (305) 531 - 4411 (305) 534-9080 marlo@goldmanproperties.com Fill out this section if principal is a Corporation, Partnership ar Trust [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: R. Anthony Goldman • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Please see att~~ched II. sPECIFIC LOBBY IssuE: Street Vendor Ordinance Issue to be lobbied (Describe in detail): 111. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship Mayor None Commissioners _ City Administration None Cit Attorne 's Office City Boards None Cit Committees MIADOCS 2906211 1 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $265 00 per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required) $265.00 per hour 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 Q No• Are You lobbying on a present or pendinq bid for goods, equipment or services, or on a present or pending award for goods, equipment or service? 2) Pursuant :o P.liami Be,~ch City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^ Yes D No: Are you lobbvina on a pendinq application for a Development Agreement with the City or application for change of zoning map designation or chanae 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 d No: Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. SIGNATURE UNDER OATH: ON OCTOBER 15 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 FILE EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist I do solemnly swear tJ~at all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained i Secti n 2-482 of the Mia r~Be ch City Cb and all reporting requirements. _ ~., Signature of Lobbyist: ~~ ~- Signature of Principal/Client:: VI . LOBBYIST IDENTIFICATION: Produced ID NOTARY PUBLIC - STATE OFFLORIDAForm of Identifi on ~~~~`' j,~~r~o t~rj~yj~j~jn (Lobbyist) `commission #DD651416 ~'•..,„ ~ Eltpit83G~~fR1RB,QAI~.~STAMP OF NOTARY: $f.W'~"13EJ THRiPllrBAhTIC ~ONIYING CU, INC. State of Florida, County of Miami-Dade Sworn to an~f subscrib bef me This Z day of , 2008 .. ~, Sign u of Public Notary -State of Florida No rization of Lobbyist's signature PRINCIPAL IDENTIFICATION: Produced ID Form of Identification Personally known (Principal) State of Florida, County of Miami-Dade Sworn to and subscribed before me This day of , 2008 Signature of Public Notary -State of Florida Notarization of Principal's signature FOR CLERK'S USE ONLY /%/' S 7 // Annual Registration fee: [ ]Yes [ ] No Amount Paid / ~ ~ .~ MCR r I Date Paid ~ `/ Lobbyist Registration Form received and verified by: ~ Revised 12/08/04 MIADOCS 2906211 1 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST CO^APENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOi3BYIST DISCLOSURE: (Required) X265 00 per hour B) PRINCIP6,L'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required) X265.00 per hour 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 CvT 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 Issi.:es": ^ Yes Q No: Arc you lobbying 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 C~1 No: Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON OCTOBER 1s` EACH YEAR, EACH LOBBYIST SHALL SUBh11T TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF h11AMl BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EX?ENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. 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 Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: VI . LOBBYIST IDENTIFICATION: Produced ID Form of Identification Personally known (Lobbyist) VII SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed Before me This day of _ , 2008 Signature of Public Notary -State of Florida Notarization of Lobbyist's signature Annual Registration fee: [ ]Yes [ ] No Amount Paid Lobbyist Registration Form received and verifed by: PRINCIPAL IDENTIFICATION: Produced ID ~- J~~/tlc~ ~ /-t.tc~r/r-S~ - Form of Identification Personally known (Principal) State of Florida, County of tvliarni-Dade Sworn to and subscribed b~fore me This .~P d'(a1I/y7of u' __._,_ " ~;,t~. i i~ .~SCy'.Y ~~~G,. tdotary Public Stale of Florida Roil0ifi~ Perez My Commission DD55hA16 Signature of Publictary - Notarization of Pr c pal's FOR CLERK'S USE ONLY MCR # Date Paid Revised 12/08/04 MIADOCS 2900211 1 Ocean Drive Improvement Association, Inc., A Non-Profit Corporation Officer Detail R. Anthony Goldman -President/Director David Wallack -Vice President/Director Marlo Courtney -Secretary/Director AI Feola -Treasurer/Director MIADOCS 2906211 1 m ni,IQi~~~IBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK office CityClerk(a~miamibeachfl.gov Tel: 305.673.7411, Fax: 305.673.7254 LOBBYIST NAME: David J. Coviello I understand that no later than October 15~ 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 for lobbyist withdrawal in writing. /Signatur$: - Date: July 21, 2008 ~._ - ._. MIADOCS 2884866 1