Rolando Llanes/Debra Klein
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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, decision 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 city board or committee. The term
specifically includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please
refer to Ordinance 20043435.
L LANES ~oGANDo
NAME OF LOBBYIST: (Last) (First) (M.I)
Gl vlc~~ L.c.c S 3 2 3,~ N.w• t 2~'" y~ # l CXo t~ora.~' ~~ ~~ ! ~-co
BUSINESS NAME AND ADDRESS Number and Street
( ) (City) (State) (Zip Code)
C~o~)5q~~q~yg C~nS)~g3•g~55' [.LANEy~ be~l~t~,~Jcf
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
L LOBBYIST RETAINED BY:
b~hra- 1L ICI ~
NAME OF PRINCIPAUCLIENT: _
N~t~1 oNl~Ff. ~ ~ ~AM,c.A G,~F R-f 1./l Sr;H'0~ ~><10A~1 oN 2C,,?-o ~OG-Y wct~o ~ ~ v ~ Nor,LY-^~~ ~ ~r.. 33 X20
BUSIN SS NAME AND ADDRESS (Number and Street) (City) _ . rota+o~
'9'~~~ 'h'f2- 4oc~4 CaS~) 3~f2 • ~ 107 --
TELEPHONE NUMBER: FAX NUMBER: (Optional) CAI
(Zip Code)_
6ttorial - -- - ~ ~
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Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c))
• 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:
uSPEGIFAIC .LOBBY ISSUE:
NOnIFlCATIoN ~ C3F'i GoNt~i'fioNA~l, USA ?Ei~L>til t'T 7~D,~ l LI1 !I-fA fi~ l LLE f7Q.
Issue to be lobbied (Describe In detail):
ul. CITY AGENCIES%I~iWDIVIDUALS"TQ B~E'LOBBIED: Pursuant to City Code Section 2-482(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 City 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 relation.
A Full Name of Individual Title. B) Any Financial, Familial or Professional Relationship
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DISCLOSURE OF TERMS AND
'• ~ IV. AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,.FLAT '
' RATE OR OTHER):.
;, . , .
.. A)"'LOBBYIST DISCLOSURE: (Required) ~D U~~Y _ ~ ~~5+ ~~h ~ ~ _
7 1' 1~JJ~ h~ .
t -~
$) PRINCIPAL' DISCLOSURE (OF L BYIST COMPENSATI N): ~ 1` ~ "
M. {Required). 6~ ~ ~ d ' ~~ ~ ~ ~~~~-~_~ !'~ GC.a e~ ~~ !'S .
The followinginformation must be answered:. ~ ..
• 1) Pursuant to Miami. Beach City Code Section 2>488 Entitled"'Prohibited Campaign Contributions By Lobbyists
'O,nt.Procurement Issues":
'^ Yes `.U No:r Are•`you lobbvinq on•a.present or pendinp bid #oi• goods equipment or services or on a
. .present or pendinp award for goods equipment or service'
' - • ~ 2} Pursuant.to Miaini Beach City Code 2-490 Entitled 'Prohibited•Campaign Contributions By Lobbyists On
' ' .. ~ Real::Estate Development Issues": ~ ,
• ' Yes ~ No: Are you lobbvinq on a pendinp application for a Development Agreement with the City or
a hcation for than a of zomn
pp q g map designation-or chantle to the City's future Land Use
" Map? .
3) ~ Pursuant to Mami.'Beach City Code 2-484. (h) Any ..person (except. those exempt from the definition of
" ~ "lobbyist" as sef forth in. Section 2-481- above) who only appears as a representative of a ,not-for-profit
' 'corporatioh 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, sha'A not be required to pay any registration fees.
0 Yes ld No: Are you representing anot-for-profit corporation or entity without special compensation or•
. reimbursement. .
- , .4 V. SIGNATURE UNDER OATHi Y •, ~ -
I do solemnly swear that ali ofthe foregoi acts re tru
provisions:contained in Section 2-482 o iam' ° ' ' h
Signature of Lobbyist:
• ' .-:_ ,
Signature of Principal/Client
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VI. LOBBYIST IDENTIFICATION: -
" ^ Produced.ID`"`
- Y F~ Not'f'° a=ry Pubic Stage otF.lorida Form of Identification. •
• .~ s
. ~o G~ (jen1a a~ry ~^ afa
~, ,• ~ MY Com s~b~~~~gcno n (Lobbyist) ,.
its"-`SIGNATURE AND STAMP OF NOTARY: '.
• State of Florida, County°of Miami-Dade
Sworn to and subscribed before me
This a~~'day of i~lo~~Q c ; ?~9 ao\C . .
° ~ '`mod ~c ~ ~: C`.~y,.;-,: ;~:.-~. u
Signature of Public Notary- State of Florida
Notarization of Lobbyist's signature
e and correct and that I have-read or am familiar with the
City Code and all reporting requirements.
• PRINCIPAL IDENTIFICATION: ~ `.
^ Produced Ib •
Form of I n
qti~ SHARON A. M~IER'
$ . c Notuy Pubt~ - Stue of flo~ldll
. fJ Pefsonally known (Prin ~~ O~
m• Aup 20, 2019
~''~ ~~ ~ ,n Commlasupn i OD Y1Sas80
State of Florida, County of IVliami-Dade
Swor r~d~subscrib~ _befor me
This ~ day of ~. ~~ , X669--.~/(7
Yh~,~
Signature of Public Notary -State of Florida
.Notarization of PrincipaPs signature
TO BE COMPLETED BY CIT CLERK'S STAFF ONLY
Annual Registratiortfee "[. ,] Yes[•. ].No sAmount:Paid:'$ ~ =-. ,.:M °# D - :Date?Paid '.
..:Lobbyist Registration Form received-and: verified iy; '
F;\Cl'fR\$ALI~\aF.QRRIS\LOBBYISTFORMS\Lobbyist Registretion'Form 211Q2doc ;Revised 02/:1.1/Z00
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City of Miami .Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk@miamibeachfl.gov
Tel: 305.673.741 1 . Fax: 305.673.7254
. ~.OBBYIST NAME: ~C~~(~ V~ ~~ ~ ~~ '
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.
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Sig ature: ate:
F:ICLERILOBBYIST1Lobbyist Registration Form 32708.doc