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2015/2016 Collier County Clerk of Courts Expires 0611201 .� 3299 Tamiami Trail E. (Clerk's o ice only) Suite 401, Bldg. F, 4th Floor Naples, Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM Lobbyist Name Clifford I. Hertz Date 9/17/15 Business Name Broad and Cassel Business Address One North Clematis Street, Suite 500 City West Palm Beach State Florida Zip Code 33401 Business Telephone (561) 832-3300 Contact Person Lobbyist/Contact E-mail chertz(abroadandcassel.com Notice for Lobbyists: The annual registration fee is 525.00 per Lobbyist,per Collier County Ordinance No. 2003-53, as amended by Ordinance 2004-05, Ordinance 2007-24 and Ordinance 2013-39. Payments made out to: Collier County Clerk of Courts or Dwight E. Brock, Clerk of Courts(ADDRESS ABOVE) NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED: 1. Name: Maruti Fleet & Mgmt, LLC 2.Name Address: 4533 Highway Avenue Address City: Jacksonville Zip Code: 32254 City Zip Code 3.Name 4.Name Address Address City Zip Code City Zip Code (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) State of Florida • County of Collier Lobbyist Signature This registration was sworn (or affirmed) and subscribed before me this 17th day of, September, 2015, by Clifford Hertz . X Personally Known BY: % -- Produced ID Deputy Cler o ary Public Type of ID Produced r`' '''• CHRISTINA L SHORE _. .� MY COMMISSION t FF 122832 V.• I U EXPIRES:May 13,2018 4 ,„�„ Bonded TMu NAM Put&UndenmlenF vised:08/2014 11C{..CIt.JIM• VV I•J.7 JLV I 9/22/2015 9:06:17 AM ��K »"" Dwight E. Brock Clerk of the Circuit Court �;,' •. .... ©ffff7 C_ _ D� o ( no '6' - Customer Deputy Clerk Clerk Office Location CLIFFORD I. HERTZ BMR CASHIER Collier County Govt. Center BROAD AND CASSEL MinutesandRecords @CollierClerk.co Building F, 4th Floor 1 N CLEMATIS ST STE 500 m 3299 Tamiami Trail East, Suite WEST PALM BEACH, FL 239-252-2646 401 i 33401-5552 P.O. Box 413044 Naples, Florida 34101-3044 1 Product QUANTITY DESCRIPTION UNIT COST AMOUNT 1 BMR Lobbyist Registration $25.00 $25.00 TOTAL AMOUNT DUE $25.00 Check#40696 ($25.00) BALANCE DUE $0.00 Note: Disclaimer: All transactions are subject to review/verification. The Clerk reserves the right to correct for clerical errors and to assess or refund charges as needed. I CCAUUTgli®TBZoggIM Page 1 of 1 Collier County Clerk of Courts Effective Date t 23\ 1J 3299 Tamiami Trail E. (Cler 's office only) Suite 401, Bldg. F,4m Floor Naples,Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST WITHDRAWAL FORM Name C 'l c-c )t l . 40'fiz Date 11 iq I Is Business Name 13 road COI ci Business Address 1 ND r+-h 1.1-0140,113- 31. , 000 City uti-Q,b 4- ea I ri4 ICj cif) , State R Zip Code 331/61 Business Telephone 5W-6312 -P00 Contact Person Lobbyist E-mail C he r+t b ro a ci an ctc aS JC,L Corn I, Clifford, I. 14-W Z. , having registered in Collier County, on as a lobbyist, hereby submit a request for withdrawal. I understand that pursuant to Section 112.3148, of Florida Statutes, that my name shall continue to appear on the list of lobbyists until the expiration of the time period set forth in said statute. My last activity as a lobbyist was on ina9 15 , 20 15 . State of Florida County of Collier Lo: r yist Signature This registration was sworn(or affirmed) and subscribed before me this q day of, N ou-em btr , 20 if , by *.r-co✓ c I . 11 er-1 Z y NAV 1'C._ Personall Known BY:Produced ID DClerk/Notary Public Type of ID Produced / ., CHRISTINA L SHORE _•• ''' :4 MY COMMISSION#FF 122632 Revised:08/2011 •�::�€r EXPIRES:May 13,2018 4,0, Bonded Thru Notary Pudic Undeneriee