Miguel A. Diaz de la Portilla/Adam Tuton, COO~e~ c~ ~~ r
m MIAMI BEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means ap pereora employed or relatned, whether petd or not, by a pMclpal who seeks b encourage the passage, detest or modlBcedon of
any ordinance, resdutton, aetion or dedsbn of any commissioner; arty acdon, decision, recommandatbn of Bte Cky Manager or any dly board or
commiae9; or any actbn, decblon or recommendaBOn of any chy pereonnei during the time pertod of the entire decblon-making process on such
actbn, declabn or recommendatbn chat foreaeeebly will be heard or reviewed by the rAy commissbn, or a city boats or commfBee. The term
speclYcalty Includes Bra prtnclpat as wag as any employee engaged M lobbying aclMties. The term "Lohbylsb" has specific srrcluslons, Plsese
refsrto grdlnanse YOg4.8435. _ f w
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loO~
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a Coraorotlon, PartnersMp or
• NAME OF CHIEF OFFICER, PARTNER, ORBENEFICIARY; /'~;• i~~~rW~+ tr "'~0~~,/ "r'~~,~I
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 6% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
Ii.SP IF C~OBBY IS~
Issue to be lobbied a in detail):
iii. CITY AGENCIES/INDIVIDUAI:S TO BE.LOBBIEiD: Pursuant to City Codo Section 2.482(8) Include
a statememt of the extent of any business, financial, familial, professlanal or other relationship, giving rise to an
appearance of an Impropriety with any City peroonnel sought to bs lobbied •- further, pursuartt to City Code Seetfon 2-
482(a)(4) Include a statement of any contractual relationship (paid or unpaid} from t2 months procading said City
psroonnsis' commoncement of service with the City to the present date, stating the general naturo of the subject
conhactual relation.
A Full Name of Individual Title B An Financial, Familial or Profeasfonal Relatlonshi
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' IV. DISCLOSURE OF TERMS AMD AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTi'iER);
A) LOBBYIST DISCLOSURE: (Requlred~.~ ~D ~ v (~ ~ l
1)
2)
present Q~pendina award for spode, eayl)R~nt or service?
Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Coniributlons By Lobbyists On
Real Estate Development Issues":
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 a not-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
secil9rf but, shall not be required to pay any reglatration fees.
reimbursement. .
V. StCaNATURE UNDER OATH:
nu nn~rnocn ,. ST ~r rwnu v,
I do solemnly swear that all of the foregoing facts are tr act and that I have read or am familiar
provisions contained in Section 2-482 of the Miami B y Code nd reporting r ulrements.
Signature of Lobbyist: ~
Signature of PrincipaUClient:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID
Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Pc6curement Issues":
Form of Identification
~ ProducedlD
Form of Identification
Personally known (Lobbyist) , ~' ~ t ~ ~ ! ~. Personally known (Principal)
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Vil. SIGNATURE AND STAMP~~IFSrI~i'.~I
~ i• . ~MMiSS~ONF ;'~/j/ I ~I~r~ ~Yy
State of Florida, County of Miami~a~ .~° "~O, •.~ ~6tate off-ferida, County of
S rn t and subscrl d afore see • ~s ~m •N sworn subs before me
Th y of ~, ~db9 March 2, 2010 N ~ ~I y of , 2009
Signatur of Public Notary- tat aI I~r ~'~arn~~,~h;'Q~ n ure of Public Notary- fate
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Notariz Ion of is t~i "~'in•,,:.;c ~~c~ ;~ Notarization of Principal's signature
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The fallowing information must ba answered:
application for chanas of zoning map desianatlon or c~8nae to the Cltv"s Future land Use
Man?
m MIAMIBEACH
Cihy o! Miami flleoeh, 1700 Convention Canter Drive, Mkrml Beach, Florida 33139, www.miam~eachH.gov
CITY CLERK O~Fice
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME:
CiiyClerk~mlamibeachfl.gov
I understand that no later than Qcttober 1st of each year, I must file the following
Forms, pursuant to Section 2,485 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
i; } 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 far code violation evaluation.
(n addition, once an issue I have registered to lobby on has been resolved, ! am required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
Signature:
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F:ICLERILOBBY131'ILobbylst Registration Form 32708.doc