Miguell Del Campillo and Eve Boutsis - Housing Authority~ ~1~~~
2 ~e5/S~u.1~'t/h~
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 boarcl or
committee; or arty action, decision or recommendation of any city personnel dudng the time pedod 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 city board or committee. The tens
specirically includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please
refer to ordinance zotl4.3435. i3oi,(~"SIS ~~/~
~~ De.l CrLr-~t~i'~l o K.tigsc ~>/
NAME Vh LVtltlYISI: (Last) (Flrst),J (M.I)
>~D I/S~ nc, y- }„t /Vls artit /' R P~ 7~a sH ~„ ~~! vtt . ~ {-C
BUSINESS ME AND ADDRE S (Number antl Street) (City) (State) (Zip Code)
30 S 53Z ~ ~ u~ ~ ., ~i, ~ ed~ n., L,~ ~ _ o,.
I. LOBB~Y~ISMT R~E~T~AINED BY:
NAME OF PRINCIPAUCLIENT:
~ n ,~- r -1-u,., 2a ~ C ~ ~ FL- ,33 ~j
BUSINESS NAME AND ADDRESS (Number and SVeet) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
FIII out this seGlon If pdncipal is a Corporation, Partnership or Trust [Section 2.482 (c)]
• NAME OF CHIEF OFFICE P TNER, OR BEMFF~CIARY:
Nl i~uec ~ !~ ~~`r'~ 1!! a
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST: N' yt ~~ p ~' L
u.SPECIFIC .LOBBY ISSUE: ~~~ ~ ~ s,
__
ssue to a lobbied (Describe in detail):
ill. CITY AGENCIES/INDIVIDUALS TO BE .LOBBIED: Pursuant to Clty Code Section 2•a82(g) Include
a statement of the extent of any business, financial, familial, professional or other relationship, giving rise to an
appearance of an impropriety with any City personnel sought to be lobbied -further, pursuant to Clty Code Section 2•
482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding said City
personnels' commencement of service with the City to the present date, stating the general nature of the subject
contractual relatlon.
A Full Name of Individual Title B An FlnanGal, Familial or Professional Relationshi
l
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ~ b
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
The following information must be answered:
_ Produced ID
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
O~n Procurement Issues":
^ Yes L~fNo: Are you lobbvino on a present or oendina bid for goods. eauioment or services. or on a
present or pending award for goods. eauioment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^ Yes dYtQo: Are you lobbvino on a oendina ao~lication for a Development Agreement with the City or
application for chance of zoning moo designation or chance to the Cltv's Future Land Use
Map9
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 snot-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.
~K( Yes ^ No: Are you renresentino anot-for-profit corooration or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
~,N'Q /~- ~ f f Signature o Lobbyist ~ "_,, Q p /t . 1/~_ _ - `~//6
I do solemnly swear that all of the for of cts are tru and corcect and that I have read or am familiar wi the
provisions contained in Section 2-482 oft Mia i Beach CI Code and all repQQOrting require nts.
Signature of Lobbyist: H, 'xc(~Str
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
~OTpRypUALiCSTA7'EdN'F7.r±RmiAd ID LF ~ identification
""• Guadalupe C. Ramos
~-Conmiission#1? 807512
"~n,,'vi*d'' Expires: S~I~is'~~Ily known (Lobbyist)
BpN!)xD THBD ATLANTIC BONDING CQ, INC.
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and,subscribe before e
This ~~l day of ~~ 2009
gylature of PubNc Notary -State of Florida
rization of Lobbyist's signature
~--
(___~
Form of Identification
^ Personally known (Principal)
State of Florida, C
Swom an~cc~~ subsG
This ~~~'~day of
of
"OTARY PUSILIC-STATE; OF FIAI2[DA
"""•- Guadalupe C. Ramos
Commission # ilt'. b07512
'•-.,,•r Expires: SEP. O8, 2012
BONDED TBBD ATLANTIC BONDING CO.,II~
of Miami-Dade
efore me
~- 2_
,~
ry -State of Florida
aPs signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid $ MCR # Date Paid
Lobbyist Registretion Form received and verified by:
Revised
~~ ~~ ~`~
City of Miami Beach, 1700 Convention Censer Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME:
~ ~u ~~~
C iryClerk@miami beachfl.gov
I understand that no later than October 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.
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//y/
Date:
/O/Z 9~~
F:ICLER\LOBBYIST1Lobbyist Registration form 32708.doc