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2020/2021
Collier County Clerk of Courts Expires I?-0? / 3299 Tamiami Trail E. (Clerk's of ce only) Suite 401, Bldg. F, 4th Floor Naples, Florida 34112 BOARD OF COUNTY COMMISSIONERS LOBBYIST REGISTRATION FORM NameDavid Hurst, P.E., LEEP AP DateJUly 15, 2021 Business Name Peninsula Engineering Business Address 2600 Golden Gate Parkway City Naples State FL Zip Code 34105 Business Telephone 239.403.6700 Contact Person David Hurst Lobbyist E-mail dhurst@pen-eng.com Notice for Lobbyists: The annual registration fee is $25.00 per Lobbyist, per Collier County Ordinance No. 2003-53, and amended by Ordinance 2004-05, Ordinance 2007-24 and Ordinance 2013-39. Please make payment(s) to: Collier County Clerk of Courts & Comptroller. (Mail to the address listed at the top of the form) NAME AND ADDRESS OF EACH CLIENT/ENTITY REPRESENTED: 1. Name See attached list 2. Name Address Address City/State Zip City/State Zip 3. Name 4. Name Address Address City/State Zip City/State Zip (ATTACH ADDITIONAL CLIENT SHEETS,IF NECESSARY) State of FloridaCounty of Collier Lobbyist Signature This registration was sworn(or affirmed) and subscribed before me this 1 5th day of July 20 21 by David Hurst - X Personally Known BY: Ktet4)04 — Produced ID - — —,—y——--— eputy Clerk/Notary Public Type of ID Produced ;' "-.'" ., KIMDc-StalSON �' ` ' Notary Public-Stale of Florida •: )t• Commission#GG 154782 My Comm.Expires Feb 19,2022 Bonded through National Notary Assn Revised:08/2019 nnnnnnnnn o Z e co m Z o Z p o n n n n n n o o n n n D D C o 2 E w K d rwo D a < C C w ,D4 < < Do , .� W ^ _ r o < o<o x x O D = = n n w = z o o m m m < o 1 -1 - s m m a = 0 F 1 > > > 1 d m 3 d .d. o O O 'm' -O c K H 0 m - ,, f Inc 0 w m = 2 f 0 0 0 m K K m F+ J '_" m z m m m Z m z A m a m d T m C N a -1 w a o1 -I m ? 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Kinzel Clerk of the Circuit Court and Comptroller czi CHI'CIRCA) O07E1—@._ _ _ j:DER Customer Deputy Clerk Clerk Office Location J. ENGLISH, J. FRUTH, J. Martha S. Vergara Collier County Govt. Center HARRELSON, D. HARTLEY, martha.vergara@collierclerk.com Building F, 4th Floor D. HURST, C. SCOTT & D. 239-252-2646 3299 Tamiami Trail East, Suite WATERS 401 PENINSULA ENGINEERING P.O. Box 413044 2600 GOLDEN GATE Naples, Florida 34101-3044 PARKWAY NAPLES, FL 34105 1 Product QUANTITY DESCRIPTION UNIT COST AMOUNT 7 BMR Lobbyist Registration $25.00 $175.00 TOTAL AMOUNT DUE $175.00 Check# 016652 ($175.00) 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. ©CAll0® kg@0n Page 1 of 1