Viviane B. Spinellim MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 .Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
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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
spec~cally includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please
refer to Ordinance 2004.3435. `
INT~i %~r?a ~Oc%y~~- 2Z3~~
USINESS NAME AND ADDRESS (Number and
TELEPHONE
(ZIP
Please notify this office if your contact information changes: address, phone, or a-mail address.
1. LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT:
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BUSINESS NAME AND ADDRESS (Num and Street) (City) (S te) (Zip Code)
TELEPHONE NUMBER: ' FAX NUMBER: (Optional) EMAIL: (Optional)
out this section if principal is a
or
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
(c)]
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION; PARTNERSHIP OR'TRUST:
n.SPECIFIC LOBBY ISSUE:
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Issue to be I bbied (Describe m detail):
III. CITY AGENCIES/INDIVIDUALS''TO BE .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 Sectiori 2= '=- ~';~
482(a)(4) include a statement of any contractual relationship (paid or unpaid) from:'12 months preceding said, City
personnel' 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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' IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
• RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required}
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). O
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyis'.s
On Procurement Issues":
^_~~ No: Are you iobbying on a present or pendinq bid for goods equipment or services or on a
present or pending award for goods equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributioris~By Lobbyists On
Real Estate Development Issues":
..
Yes •1dl No: Ar'e vou~iobbying on a pendinq application for a Development Agreement with the Citv or
implication for change of zoning map designation or change to the Citv's Future Land Use
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 anot-for-profit corporation or entity without special compensation or
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reimbursement. '.
V. SIGNATURE UNDER OATlt: -
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Signature of Lobbyi
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/C
I. LOBBYIST IDENTIFICATION:
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~~ ,Produced l g(`~Sf-~roa-C~9 ;5'9o-U
aD Form of Identification
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~~~• ~ ^ Personally known (Lobbyist)
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,~~ VII. SIGNATURE AND STAMP OF NOTARY:
•.,, State of Florida, County of Miami-Dade
~`` ''°'~~ Sworn to and subscribed befQQ~r'e me
r,'~~~{{ f~ This ~_day o//f~~ !Je"'~ (,~2D10
oqV RI,iNt~ / / `~
Signatur of Public Nat -State of Florida
Notarization of Lobbvist's signature
PRINCIPAL IDENTIFICATION:
~roduced ID ~G~D~-~'S/S~Y• ~(0.2 '~ j~ •~~~
Form of Identification
^ Personally known _.
~1~: ~•= ISABEI SATCHEl1
• s MY COMMISSION N DD 879891
~•~'~I EXPIRES: April 13, 2013
~~pf ty?~`' Bonded Thru Notary Pubttc Underwriters
State of Florida, Cou
Sworn and subscribed before me
This~~day of dlllC , 2010
Sign ure of Pub tc~ -State of Florida
Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF
Annual Registration fee: [ j Yes [ j No Amount Paid $ MCR # Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form 2010.doc Revised Q5/-2010
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER): _
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION)
(Required). ~
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^_~K1 No: Are you lobbving on a present or pendirtg bid for goods equipment or services or on a
present or pending 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":
application for change of zoning map designation or change to the City's Future Land Use
' Map?'.. ..
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.
,leap Yes ^ No: Are you representing anot-for-profit comoration or entity without special compensation or
. •reimbursement.: ~ .
V. SIGNATURE UNDER OATH:
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/C
I. LOBBYIST IDENTIFICATION:
~~~ ~
~~~ Produced I 9l5~-~6a-~9 :s9o-v
g ~; Form of Identifcation
~ ~ ~
^ Personally known (Lobbyist)
~~ VII. SIGNATURE AND STAMP OF NOTARY•
;.•, State of Florida, County of Miami-Dade
~`""° ~ Sworn to and subscribed bef re me
:~ This day of ~, 2010
~`t't„ ~•• ~ ~~~j v
~~ V
Signatur of Public Nat -State of Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
Produced ID FG.~~-`.S/5~•FS(o,2 'i6~f -~O~
Form of Identification
^ Personally known.
. ~~ '••.= IsASa salcHat
$*i :.
r MY COMMISSION 11 OD 819891
'~? EXPIRES: April 13, 2(113
,j~ ~~„ Bonded Thru Notary Publk Undervmters
State of Florida, Cou
Sworn and subscribed before me
This~,_day of V C , 2010
Sign ure of Pub c -State of Florida
Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes [ J No Amount Paid $ MCR # Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL \aFORMS\LOBBYIST FORMS\Lobbyist Registration Form 2010.doc Revised Q5/F5.l20Z0
Signature of Lobbyi
m /V~iAN~IBEACH
City of Miami Beaeh, 1700 Convention Center Drive, Miami Beach, Florido 33139, www.miamibeachfl,gov
CITY CLERK Office
Tel: 305.673.7411 ,Fax: 305.673.7254
CityClerk@miam ibeachfl.gov
Acknowledgement of fines/suspension from lobbying for failure to
comply with City of Miami Beach lobbying Laws
LOBBYIST NAME:
I understand that no later than October 1st of each year, lobbyists subject to lobbyist
registration requirements shall submit to the city clerk a signed statement under oath
listing all lobbying expenditures, as well as compensation received, for the preceding
calendar year with regard to the specific issue on which the lobbyist has been engaged
to lobby. A statement shall be filed even if there have been no expenditures or
compensation during the reporting period. The statement shall list, in detail, each
expenditure by category, including food and beverage, entertainment, research,
communication, media advertising, publications, travel,, lodging and special events.
FAILURE TO TIMELY FILE THE EXPENDITURE AND FEE DISCLOSURE REPORT
WILL RESULT IN A FINE OF $50.00 PER DAY. ANY LOBBYIST WHO FAILS
TO FILE THE REQUIRED EXPENDITURE REPORT BY DECEMBER ' 1, SHALL
AUTOMATICALLY BE SUSPENDED FROM LOBBYING UNTIL ALL FINES ARE
PAID, UNLESS THE FINE HAS BEEN APPEALED TO THE MU4M1-DADS COUNTY
COMMISSION ON ETHICS AND PUBLIC TRUST. In the event a lobbyist fails to
either file the report and/or pay the assessed fines, the Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust.
IN ADDITION, ONCE AN ISSUE I HAVE REGISTERED TO LOBBY ON HAS
BEEN RESOLVED, 1 AM REQUIRED TO IMMEDIATELY NOTIFY THE CITY
CLERK'S OFFICE OF LOBBYIST WITHDRAWAL IN WRITING.
.~
Signature: Date: