County of Los Angeles INSTRUCTIONS FOR LOBBYIST EMPLOYER REGISTRATION STATEMENT FORM LOB 3 Chapter 2.160 of the Los Angeles County Code The Lobbyist Employer Registration Statement is used for: x x The registration of a person or entity that employs one or more in-house lobbyist(s) The registration of a person or entity, other than a lobbying firm, that contracts with a lobbying firm or individual lobbyist. FILER REQUIREMENTS: Any person or entity, other than a lobbying firm, who employs or contracts with one or more lobbyists for economic consideration, other than reimbursement for reasonable travel expenses, for the purpose of influencing official county action must file the Lobbyist Employer Registration Statement (Form LOB 3), pursuant to Section 2.160.040 of the Los Angeles County Code. DEADLINE FOR FILING REGISTRATION: A lobbyist employer required to register with the Executive Officer of the Board of Supervisors must do so within ten (10) days of becoming a lobbyist employer. REGISTRATION REQUIREMENTS: In addition to the Lobbyist Employer Registration Statement (Form LOB 3), submit the following: x x A $75 Registration Fee, made payable to the County of Los Angeles, if registration is filed between January 1st and September 30th. If registering between October 1st and December 31st, the cost of registration is $56. A Lobbyist Certification Statement (Form LOB 4) completed by each in-house employee lobbyist, if applicable. ACCEPTABLE METHODS OF REGISTRATION PAYMENT: You may submit your registration payment to this office by way of cash, check, money order or through the use of our online payment system. To access our electronic payment system, go to: http://bos.co.la.ca.us/Categories/TermAcknowledge.html AMENDMENT TO THE LOBBYIST EMPLOYER REGISTRATION STATEMENT: In the future, if there is any change in the information contained in this Lobbyist Employer Registration Statement (Form LOB 3) an Amendment to Registration Statement (Form LOB 5) must be filed within ten (10) days of the change. VERIFICATION: The Lobbyist Employer Registration Statement (Form LOB 3) must be verified and signed by the responsible officer of the organization. The signature of an attorney or a certified public accountant on behalf of the organization will also be accepted. FILE THIS FORM WITH ORIGINAL SIGNATURE WITH THE: INTERNET ACCESS Executive Officer of the Board of Supervisors County of Los Angeles Kenneth Hahn Hall of Administration 500 W. Temple Street, Room 383 Los Angeles, California 90012 (213) 974-1093 Rev. 1/11 The Los Angeles County Lobbyist Ordinance, rules, operational procedures, registration/reporting forms, and information on registrants and their quarterly activity reports are accessible at: http://bos.co.la.ca.us/ American LegalNet, Inc. www.FormsWorkFlow.com OFFICIAL USE ONLY COUNTY OF LOS ANGELES Lobbyist Employer Registration Statement Form LOB 3 Enter Date Qualified As Lobbyist Employer: Lobbyist Employer Name: Business Address: City: Mailing Address: (If different than Business Address) City: Area Code & Telephone Number: (No Dashes) Electronic Notice to File Quarterly Lobbying Reports Registered Lobbyist Employers and their In-house Lobbyists are required to file quarterly lobbying activity reports. At least three week prior to the filing deadline the Executive Office of the Board of Supervisors will mail you the necessary reports, or you may choose to receive an electronic reminder notice to file. The electronic reminder notice to file will be sent to the electronic mail address you provide. It will be your responsibility to notify our office of any change to your electronic mailing address. Upon receiving the reminder notice to file, you must click on the appropriate link to access the required report(s). Once you complete the report(s) you must print, sign and mail the report(s) with an original signature, along with the required filing fee to our office. If you would like to receive your reminder notice to file and lobbyist reports via electronic mail please check the box below and provide a primary and alternate electronic mail address. Electronic Notice to File Primary E-Mail Address: Alternate E-Mail Address: Part (A) Lobbyist and Lobbying Firms Employed List the full name of each in-house lobbyist employed and each lobbying firm with which you contract. Each in-house lobbyist listed must attach a signed Lobbyist Certification Statement (Form LOB 4). State: Zip Code: Extension: Area Code & Fax Number: (No Dashes) State: Zip Code: In-house Employee Lobbyist: Name of In-house Lobbyist: Lobbying Firm (Including Sole Proprietorships): Name of Lobbying Firm: Name of Lobbying Firm: Name of In-house Lobbyist: Name of In-house Lobbyist: Name of Lobbying Firm: American LegalNet, Inc. www.FormsWorkFlow.com County of Los Angeles Lobbyist Employer Registration Statement Form LOB 3 LOBBYIST EMPLOYER NAME: Part (B) Description of Employer's Lobbying Interests: Check one box to describe you or your organization: 1. BUSINESS ENTITY INDIVIDUAL (Complete description below) Description of Business Activity: 2. INDUSTRY, TRADE OR PROFESSIONAL ASSOCIATION (Complete description below) Description of Industry, Trade or Professional Association: Specific description of any portion or faction of the industry, trade or profession which the association exclusively or primarily represents: Number of members in association (check appropriate box) Less Than 50 (Attach List of Members) 3. OTHER (Complete description below) More Than 50 Statement of Nature and Purpose: Description of any trade or profession or other group with a common economic interest which is principally represented or from which membership or financial support is principally derived: Part (C) - VERIFICATION I have used all reasonable diligence in preparing this Statement. I have reviewed this Statement and to the best of my knowledge the information contained herein is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date Executed: City: State: Name of Responsible Officer: Signature of Responsible Officer:__________________________________ American LegalNet, Inc. www.FormsWorkFlow.com