Diana M. Maldonado/Miami Beach Watersports Centerv~ ~
~ MIAMI BEACH ,~ ,.....~ ,s; I-- ~_I
City of Miami Beach Office of the City Cierk ~~, ~ ~ ~~ ~; 3~
170Q Convention Center Drive, Miami Beach, FL ~~~
LOBBYIST REGISTRAT~N FORM L ~ ~ 1' +.; '[_ ;_:'t ='+ ~ ~ {J ~ t i t, ~
Lobbyist ai- persons emWoyea a retained, vMther w;a a noe, ay a prindpal who .~ a x~courape the persape, der~t a modficatior- of
any ordinance, reaoiuuon, action or dsciaion a any ~ ar~y ecuon, deasion. ~ a the ety Manager or arty ~y bwrd or
oormm~tee: or amr acdion, deasion or rseorruton d em sty persannal dwiro the time period of ms entlro asasac-~r~ pmc~es o~ ~„a,
adorn, deasion or reoomdon that taeaesabiy wiu be beard or revieMrod by the eny corrxr~aewn, or a a-y board or conur~tas. Tne term
eper:ificagy u-dudee the pdrropW ea weu as any snKAoyee engaged in lobbying activ~iee. TM Mrm "LObbybris" tae st»et8c atdwiona. Pleere
raAer w oedtnanca 2oo~-seas.
Maldonado ~iaylGl M.
ur nr ~ noev~er. n .,es~ /ki.aF\ !M R
~~am- ~eac~ ~Ila-kr5po~-~5 C->'r~ !0500 T~d-an
iUSINESS NAME AND ADDRESS r (Nun mbar a d Stns (Cky)
305- Sts?r- $$3~ 305- 8101- 884~~ dig
1. LOBBYIST RETAINED BY:
~mi ch ~G 33~~J
~~ ~ ~~~~
out
or
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ~ 0~~~ (,(~ Share
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIR CTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST: N~q
rni ~~aeh V'C~ C'~rdn-~ A~oli~aftD~ ~- ~o
NL : PurowM to City Cods Section 2-482(91 Inelud~
a sfatemetK of fhe sxbent of any btasirwse, financial, famf8al. prohsslonai or other rolaNonehip, glvkt3 rlae bo an
ap~pearartcs of an impropriety wNh any City pentonnsl soupM to be lobbied - furtMr, purouant to Oily Cods Sstdlort 2-
482(a)14) include a stabrrmk of any contractwtl rolWonship (paM or unpaid) iron 12 nantM procsding satd City
peraonrwla' corranenwment of seevfce with tM Chy to the proeent date, atatiny tM gerwrol naWro of the subject
torKractuai roladon.
A FuN Mama of IndivMuai B M Financial, FamtNal or Profies[onai Relatlonsh
Miami P eat ACA nlfln~
N. DISCLOSURE OF TERM8 AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER
A) LOBBYIST DISCLOSURE: (Required) ,, +~,np
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPE"NVSATION): ~D~~
(Required).
The fonowing irrfon~nation must be answered:
1) Pursuant to Miami Beach City Code Section 2.488 Entitled "Prohibited Campaign Contributions By tobbyists
On Procurement Issues°:
r
oresent or nendins~ awa(rr~ #g~ggp~, eaui~-,~, or seMceT
2) Pursuant to Miami Beach City Code 2-490 Entitled 'Prohibited Campaign Contributions By Lobbyists On
Rear Estate Devebpment Issues":
n
$ooll chance of zoning man desistnatlon or chance to the Citv's Fuhrre ~~
MaD~
3) Pursuant to Miami Beach City Code 2-4$4 (h) Any person (except those exempt from the defMition of
°IobbyisY as set forth in Section 2-481 above) who only appears as a representative of a no~for-profit
corporation or entity without apeaal compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any itren, shall register with the dark as r+equir+ed by this
section but, shall not be required to pay any registration fees.
Y r s
rehrt , .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist: ~PS(~lfiy/'UKL`'r
Signature of PrinapaUCtient: ~.~„
VI. LOBBYIST IDENTIFICATION:
1'~
~Z:ed ID
~ s Form of Identifit~Uon
e Personally known (Lobbyist)
~ ~
°~ereo~~ VII. 51GNATURE AND STAMP OF NOTARY:
State of Fkxida, County of Miami-Dade
Swom to srnd subscribed before me
This .~7 iday of 5 ~ ~ , 2009
Signature of Pubic Notary -State of Fbrida
Notarization of Lobl~,st's signature
PRINCIPAL tD@NTIFICATtON:
~ Produced ID
Form of Identification e1 ~2
~c ~°'
~Personaliy known (PrMc ~'~°~' ~ g~
~ • ~~
'''~ara
State of Florida, County of Miami-Dade
Swom and subscribed before me
This J ~ day of _„~~~, 2009
Signature of Public No~ry -State of Florida
Notarization of ~~ t'a signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
I do sotemniy swear that all of the foregoing facts are true and correct and that i have read or am familiar with the
prov~ions contained in Sedi¢n 2-482 of the Miami Beach City Code and all reporting requirements.
m MIAMIBEACH
C'~r of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachR.gov
CITY CLERK Office CityClerk~miamibeachfl.gov
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME: ~ iana ~laldo~Gdo
t understand that no later than October 1st of Both. y~.ear, I must file the following
forms, pursuant to Section 2-~t85 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.
G(-D ~' J ~'~ D~J
Signature: Date:
F:\CLERILOBBYISTILobbyist Registration Form 32708.doc