Fillable Office of the City Clerk City of Homestead (City of Homestead, Florida)

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Office of the City Clerk City of Homestead (City of Homestead, Florida)

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Office of the City Clerk
City of Homestead
100 Civic Court
Homestead, Florida 33030
Telephone: (305) 224-4445
2021 LOBBYIST REGISTRATION (City Code Section 2-590)
I. Lobbyist Information
Lobbyist Name:
Mailing Address:
Business Phone: Fax No.:
E-mail:
II. Principal Information
Name, address and phone number of your Principal: (i.e., person, business entity, corporation or
association whose interest you represent or by whom you are employed)
Name:
Mailing Address:
Phone Number:
Identify in an attachment, any other persons holding directly or indirectly a 5% or more ownership interest
in the Principal.
III. Authorization of Principal
Prior to lobbying, provide to City a letter from your Principal stating that the Lobbyist is authorized to
represent the Principal.
Check applicable: ____ Letter is attached.
____ Lobbyist will file letter prior to lobbying.
IV. Fees Payable by Lobbyist
Check all that are applicable:
(a) ___ New Lobbyist Registration - $200.00 fee per Lobbyist.
(b) ___ One-time fee (not annual) of $100.00 for each Principal represented by Lobbyist.
The fee is payable upon filing of Lobbyist registration for each Principal
represented by Lobbyist in City matters.
(c) ___ Lobbyist Registration Annual Fee of $200.00 per Lobbyist. This fee is payable as
of January 15
th
of each year.
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V. Miscellaneous Requirements
(a) Pursuant to Section 2-11.1 (q) of the Miami-Dade County Code, have you served on the
City Council or been an employee of the City in the last two years? Check applicable:
Yes No If yes, state the position or office which you held in the space
provided below, since you may be barred from lobbying the City for a period of up to two
years from the time you left your former office or position.
(
b) Pursuant to Section 2-11.1 (s) of the Miami-Dade County Code, as adopted by City Code
Sec. 2-590, a Lobbyist shall state the extent of any business or professional relationship
which the registrant has with any member(s) of the City Council. (Please state below)
(c
) Pursuant to Section 2-11.1 (s) of the Miami-Dade County Code, as adopted by City Code
Sec. 2-590, any person who registers as a Lobbyist shall file an expenditure report listing
all expenditures, by category, by principal and in excess of $25.00. A statement shall be
filed even if there have been no expenditures during the reporting period, (i.e. for the
preceding calendar year). The expenditure report is due each July 1
st
at the office
of the City Clerk.
OATH
“
I DO SOLEMNLY SWEAR OR AFFIRM THAT ALL OF THE FOREGOING FACTS ARE TRUE AND
CORRECT AND I HAVE READ OR AM FAMILIAR WITH PROVISIONS CONTAINED IN SECTION 2-
11.1(S) OF THE MIAMI-DADE COUNTY CONFLICT OF INTEREST AND CODE OF ETHICS
ORDINANCE, INCLUDING WITHDRAWAL AND REPORTING REQUIREMENTS, AS ADOPTED BY
CITY CODE SECTION 2-590."
Signature of Lobbyist: Date:
State of , County of
Sworn to and subscribed before me by the above described Lobbyist on this day of
, 20 .
Notary Public
M
y Commission Expires:
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Registration accepted this day of , 20__.
Fee paid: $ Cash Check #
Deputy City Clerk/City Clerk
Should you have any additional questions regarding the registration and reporting requirements which are
applicable to you, you may call the Miami-Dade County Commission on Ethics and Public Trust at (305)
579-2594. Questions concerning fee information should be directed to the City Clerk.
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Office of the City Clerk City of Homestead (City of Homestead, Florida)

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Completed 22 July 2021

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