Fillable Open Government Commission 2180 Milvia Street Berkeley, CA

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Open Government Commission 2180 Milvia Street Berkeley, CA

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Open Government Commission
2180 Milvia Street
Berkeley, CA 94704
(510) 981-6900
www.cityofberkeley.info | FCPC@cityofberkeley.info
Page 1 of 2
LOBBYIST REGISTRATION FORM
(Berkeley Municipal Code Chapter 2.09 – Lobbyist Registration and Regulations)
No person shall act as local governmental lobbyist before registering as a local governmental lobbyist with
the Open Government Commission, through the office of the City Clerk. Lobbyists are further required to
file a Quarterly/Annual Disclosure of Lobbying Activities no later than 30 days after the end of
the reporting period. BMC 2.09.060
PART 3. LOBBYIST’S CLIENTS
The name, business address, and business telephone number of each client for whom the local
governmental lobbyist attempts or receives compensation to influence any proposed or
pending governmental action of the City. BMC 2.09.060 B.3. Attach additional information, if
needed.
1. NAME
PHONE NUMBER
ADDRESS
PART 1. IDENTIFY THE LOBBYIST
LAST NAME
FIRST NAME
M.I.
NAME OF LOBBYING FIRM OR EMPLOYER
LOBBYING FIRM OR EMPLOYER BUSINESS ADDRESS
STATE
ZIP
WORK PHONE
WORK EMAIL
PART 2. TYPE OF REGISTRATION
(Please Check all that Apply)
Initial Lobbyist Registration
Annual or Renewal Lobbyist Registration
Amendment to Lobbyist Registration
Termination of Lobbying Activities
□ 501(c)(3) or 501(c)(4) – Must Attach
Determination Letter
□ Lobbying Firm with Four or Fewer Employees
$500 fee required, except qualified non-profits.
Date Filing Received
Official Use Only
Fee Paid ($500)
CLEAR FORM
Page 2 of 2
2. NAME
PHONE NUMBER
ADDRESS
3. NAME
PHONE NUMBER
ADDRESS
4. NAME
PHONE NUMBER
ADDRESS
5. NAME
PHONE NUMBER
ADDRESS
6. NAME
PHONE NUMBER
ADDRESS
7. NAME
PHONE NUMBER
ADDRESS
PART 4. FILING UNDER PENALTY OF PERJURY
I have reviewed and understand Chapter 2.09 of the Berkeley Municipal Code regarding Lobbyist Registration and
Regulations. I have exercised reasonable diligence in the course of reviewing this Registration Form for
completeness and accuracy. I declare under penalty of perjury under the laws of the State of California that the
contents of this Registration Form, including all attachments, are true, correct, and complete, except as to those
matters which are stated on information and belief, and as to those matters I believe them to be true.
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Open Government Commission 2180 Milvia Street Berkeley, CA

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Completed 12 May 2021

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