Rolando Aedo~' 1~AlV~IBE~~H ~~~~,~~
~~
?OQg J,~
City of Miami Beach Office of the City Clerk ~ 2& Pty ~: j 8
1700 Convention Center Drive, Miami Beach, FL 33139 C! r y eC E p~ ~s OFF I
LOBBYIST REGISTRATION FORM e~
Lobbyist means ail persons employed or retained, whether paid or not, by a principal who seeks bo encourage the passage, defeat
or modification of any ordinance, resolution, action or derision of any commissioner; any anion, derision, recommendation of the
Gty Manager or any city board or committee; or any adios, derision or recommendatlon of arty dty personnel during the time
period of the entire derision-maWng process on suds action, dedslon or recommendation that foreseeabiy will be heard or reviewed
by the rity commission, or a rity board or committee. The term sperifically indudes the prinripal as well as any employee engaged
in lobbying activities. The tenor "Lobbyists° has specific exclusions. Please refer to~ finance 2004-3435.
~ ~d.o o ~-
NAME OF LOBBYIST: (Last) , (First) (M.I)
~' - ~ ~1~-nn~ ~ 1~6 `70 ~ ~~rc~t~! ~~ a7QO ~' F~ l~~
BUSINESS NAME AND ADDRESS (Number and Street) (Gty) (State) (Zip Code)
SOS 5~~t-~o~o ~o.S-s3o-~aq~2o1n,~7~o ~ c~-mcvQ, cow/
___ cw ~u iuicco EMAIL
L LOBBYIST RETAINED BY:
:.. ~.~ ,~
~ I`[ ii'}tVli c'~U ~
:SS NAME AND ADDRESS
s- 5~9 - ~c~oo
1 b~r~T -~ G~~~
__
`?DI ~~2lcke:~~ ~V~ .~a~oo
lumber and Street) (Gty)
j~s- s~9 - ~ia5
ZONE NUMBER:
Fti l- r~ i c v~
i GL ~3~~1
(~ p Code,
gut this section if prinapal is a Corporation, Partnership or Trust [Section 2-482 (c)]
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECRY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP ORTRUST:
II. SPECIFIC LOBBY
} A.. 1
Issue tiD be lobbied (Desa'ibe in detail): //
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: '
A) Full Name of Individuai/Title B Any Financial, F milial or Professional Relationship
)
~~
'r~.~o ~,j~~1,
~? ,:, .,.. .
.
~£ ~d E- 83 j ,
',". is
~.~
C%~ ~ ~c
a»
~ ~ N =Q
-. ~, ux
~, ~~
~~,~;~
~~~'`~'
~Q
n/, DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^ Yes ^ No Are you lobbvina on a present or pending bid for goods equipment or services or on a
pr nt or pending award for goods eau~pment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
with the City or
Yes ^ No Are you lobbvina on a pending application for a Development Agreement
a I~cation for change of zomna map des~anat~on or chance to the C~tv's Future Land Use
Ma°?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of anot-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees..
^ Yes ^ No Are you representing a not for profit corporation or entity without special compensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD.
Signature of Lobbyist
~~
~a~~
~~~
oo~
3
~_
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisions contained in Section 2-482 of~ Miami Beach City Code and all reporting
requirements. ~~ , ~., n
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Lobbyist)
SIGNATURE AND STAMP OF NOTARY:
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn to and subscribefi before me Sworn and subscribed before me
This ~_day of JA~os 20 09 This day of , 20_
Signature of Public Notary -State of ri a 1 Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
FOR CLERK'S SE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid ~' MCR # Date Paid
Lobbyist Registration Form received and verified by: Revised 12/08/04
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc
~,
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, ~ ,. i; a
07HER
~M ~ lo~e~
A) LOBBYIST D . i
B) PRINCIPAL'S DISCLOSUt2E (OF LOBBYIST COMPENSATION): (Required). lS i~ l ~ iiC2l1 ~'V`~( ~~ ~~'
The following information must be answered:
i) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
p,~~No Are you lobbvina on a present or pending bid for goods, equipment or services or on a
~, ~~ or pending award for goods eouipment or sere
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
FLAT RATE OR t
ISCLOSURE• (Required)
Mao?
3) Pursuant to Miami Beach C'~ty Code 21184 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of anot-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees..
^ Yg~~No Are you representing snot-for-profit corporation or p~rtity withoc~* special comps on
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1'r OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD.
Signature of Lobbyist
~~~
~~g
o:~
~~
I do solemnly swear that ail of the foregoing facts are true and correct and that T have read or am
familiar with the provisions contained in Section 2-482 of Miami Beach City Code and all reportlng
requirements.
Signature of Lobbyist:
Signature of Principal/Client: ~ ~cVQ
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID
Farm of Ident~cation
Personally known (lobbyist)
SIGNATURE AND STAMP OF NOTARY:
^ Produced ID
ct
~~
~~~
~g
d~
~_
Form of Identification
Personally known (Principal)
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
Swom to and subscri before me Swom nd subscribed before me
This ~_day of~ANUk 20Q9 This ~d of 20fl
Signature of Public Notary -State of ri a Signature of Pu 1ic Notary - fate of FI a
Notarization of Lobbyist's signature Notarization of Principal's signature
FOR CLERK'S USE ONLY L
Annual Registration fee: ]Yes [ ] No Amount Paid ~,~ MCR # Date Paid
Lobbyist Registration Form received and verified by: Remised 12/08/04
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc
y ~ k~ t •' ~ ,~`
City of Miami 8eoth, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK OF~ice CityClerk@miamibeachFl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: ~o I A'~ (~0 a C ~ O
- -___ I ~
I understand that no later than October 1st of each year, I must file the following
forms, pursuant to Section 2-485 df the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
1) lobbyist Expenditure Form
2) Disclosure Form
Failure to file these forms on a timely basis will result in my name being transmitted to the
Miami-Dade County Commission on Ethics and for code violation evaluation.
In addition, once an issue I have registered to lobby on has been resolved, I am required
to immediately notify the City Clerk's Office of lobbyist wi#hdrawal in writing.
I~~~visa~l o~,~ar2oos
,:,. >., ,:. r,. ~...