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Gregg Caren/SMG~, ~"~ ; l~ /'~ e Y t" w~ s!f \r~~11 s E ~.~'t .~ ~_~ 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 inGudes the principal as well as any employee engaged in lobbying activities. The term "lobbyists" has specific exclusions. Please refer to Ordinance 2004J435. Pr12~~ ~(2000- NAME OF LOBBYIST: (Last) (First) (M.I) 70l MaYk~- sT. ~~-,;1Q~lp~,-~L PR i~~©(~ BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) ' (Zip Code) a~~- 5aa- ~~~~ z(~- saz-~c~~~ ~~.~~@s~t~w,~~~et ,cA„, TELEPHONE NUMBER: FAX NUMBER: MAIL: LOBBYIST RETAINED BY: s m ~, NAME OF PRINCIPAUCLIENT: ~~ ~ ~ (O -7 O 1 i~ Pt 2 K.1r T S-r. ~~ ~ ~ a dle. ~~p ~, ~ a BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Lip Gooe) ZIS- TaL- X100 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a or 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: II.SPECIFIC LOBBY ISSUE: ~I FP Zo - o-t ~~ 8 M a nQ ~.c. vy~, l ®~ K ~ Q. rh ; I~eacQ~ ~n v~-~"ar '~ ~ir- . be lobbied (Describe in detail): lll. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City code section z~82(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(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.) f Individual Title A Full Name o cial, Familial or Professional Relationship 8) Any Fina n 1 _ ~~ T" MQr~4 ` ' /~'U !"IQ p~ GtmC~ 1.67v-'-mi Ss~`~vr~ r~0 . jai ~~~ S.~'~~~i~ Ally ~~ w~ o E inr soot IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): y ~55 ~~~A ~$ ~~ A) LOBBYIST DISCLOSURE: (Required) Q 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": IJ Yes ^ No: Are you lobbvina 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 L7 No: Are you lobbvina on a sending application for a Develoament Agreement with the City or application for change of zoning maa designation or change to the City's Future Land Use Man? 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 LJ No: Are you representing snot-for-arofit coraoration or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: A\I A/'.TA~C~ AsT /~C CA/~\l VI 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 ~ Produced ID Form of Identification PRINCIPAL IDENTIFICATION: Personally known (Lobbyist) Form of Identification Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn d subscribedyefQj~ me This ~ ~ day of J tt 1,~1 .2008 Signature of Public Notary -Strife of Florida Notarization of Lobbyist's signature State of Florida, County of Miami-Dade Swor and subscnb efore me Thi f7 day of _~, 08 Signature of Public Notary -State f Florida Notarization of Principal's signature TO BE COMPLETED BY CITY LERK'S STAFF O Annual Registration fee: [ ]Yes [ ] No Amount Paid S MCR # Date Paid Lobbyist Registration Form received and verified by: F:\CLER\LOi38YIST\Lobbyist Registration Farm 32708.doc ^ Revised 03/27/20 8 g~ ~~~~ ~ ~~ ~~~ ~~ m City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, wvrw.miamibeachfl.gov CITY CLERK Office Tel: 305.673.741 1 ,Fax: 305.673.7254 LOBBYIST NAME: CityClerk@miamibeachfl.gov V I~G G C., ~~'~- of 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 ~ 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. ____ _ ~ ~ S' at ate: F:\CLER\L{?BBYIST\Lobbyist Registration Form 32708.doc