Michael A. Hernandez (2)•_.1 ~ C/
m MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat
or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the
City Manager or any city board or committee; or any action, derision or recommendation of any city personnel during the time
period of the entire decision-making process on such action, decision or recommendation that foreseeably will be heard or reviewed
by the city commission, or a dty board or committee. The term specifically includes the principal as well as any employee engaged
in lobbying activities. The term "Lobbyists" has speafic exclusions. Please refer to Ordinance 2004-3435.
H~r h~ ycd-C~ 1M r char! ~ ~•
NAME OF LOBBYIST:
8~-.s.~~~ e~~~~~« (Last)
<.+~o,~s 3663 (First)
S.CI~. 8~ ~~-ru (M.I)
.-~, S~ti•K. ?.ap . IM~c-wti AFC
BUSINESS NAME AND ADDRESS
3 65 . ~ 1.1272 (Number and Street)
36s . 44/ . zs (City)
~ 8 7 (State) (Zip Code)
i'/I M 6KAI.ENDE~C~ S~cs~~t
TELEPHONE NUMBER: FAX NUMBER: EMAIL: -
I. LOBBYIST RETAINED BY:
t~tarr~ 1M-c U.bh
NAME OF PRI PAL/CLIENT:
Tie ~70f~Gf'IQ`l
BUSINESS NAME AND ADDRESS
~l~~f. 4G7.9333
TELEPHONE NUMBER:
and Street) ~ (City)
$IP4. Z33.q~06
FAX NUMBER: (Optional)
EMAIL:
. ~owi
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
ebb 8Yd•Zr CoVr4-raG~'rr~a~ r!JbC>
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: C7 -v
T o
A) Full Name of Individual/Title -< `°
B) Any Fnancial, Familial or Professional Retlatior~jp
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Co wtwt~9sreVrers ~ 6'l'Ca ar m _.
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(Zp Code)
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERI.
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COM
The following information must be answered:
- ~ S
(Required). ~ d n.Tn `"'V ~ S. dd Q
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^ Yes C~NO' Are you lobbvina on a present or cending bid for goods equipment or services, or on a
present or cending award for goods equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes l~No• Are you lobbvina on a cending application for a Development Agreement with the Ciri or
application for chance of zoning man designation or chance to the Ciri'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 snot-for-profit corporation or entiri without scecial comcensation
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 COMPENS ON DURING THE
REPORTING PERIOD.
, ~! ~/ r
i nature of Lob ist
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 the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
~~.~~
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
Produced ID
Form of Identification
/ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This 1_~._._dav-af;"'t.~~, , a0~
na ure-3'FP~1' ate of Florida
Notarization of Lobbyis signature
PRIN~I AL IDENTIFICATION:
~ Form of Identification ~ ~
~ S~ ~.
gQ .~ ersonally known (Principal) ~y~n
op~ a to of Florida, County of Miami-Dade $.
a ~ orn and subscribed before me ~ ~
is ~$_da of T3 L 20 a`1 ~" "
~.--T.~-.-,._.......... _......~~ -.~
FOR CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid ~ MCR
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc
bl2~Pl~te of Florida
2ofmPr~incipal' signature
~v ` ~ Date Paid ~~ ~
~~ Revised 12/08/04
City of Miami Bspch, 1700 Convention Center Drive, Miomi Beach, Fbrida 33139, www,miamibeachfl.gov
CITY CLERK Office CityCferkCmiamibeachf{.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: W~1 C~Ia~.G ~• N~rna~dz~
I understand that no later than Ocbber ~t of each dear. 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.
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 withdrawal in writing.
~• ~ l
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Signature: Date:
F:ICLERILOBBYi5TlLobbyist Registration Form 32708.doc