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Leone Lima - Blue Diamond Condo Assoc~~ o~~~ Cit of Miami Beach Office of the Cit Clerk Y Y 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REG{STRATTON FORM Lobbyist means all persons employed or retained, whetherpaid or not, by a prinapal 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. aty board or committee; or any action, decision or recommendation of any city personnel during the time period of the entire deasion-making process on such action; decision or recommendation .that foreseeably will be heard or reviewed by the city commission, or a aty board or committee. The term specifically includes the prinapal as well as any employee engaged in lobbying activities. The tenm "Lobbyists" has.speclfic exclusions. Please refer to Ordinance 20043435. NAME OF LOBBYIST: (Last) (First) (M.I) BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code), .~os~ 333-~~' e_1 i m alnoo . TELEPHONE NUMBER: FAX NUMBER: E IL: CQ Please notify this office if your confect information changes: address, phone, ore-mail address. I. .LOBBYIST RETAINED BY: ~ ~ ~ X1 iN ~ ~ ~~ L ~ l U 1~t~SC~-1 ~4TI Z~J\I NAME OF PRINCIPAUCLIENT: ~~~ ~. Coup nS ~~~tt„~. ~ic.~m.~ ~~~~ ~ ~~1~- C~ BUSIN~sS~NAMF~ND ADDRESS (Num and Street) Cit (Zip Code t.~QS) Co'^i 2- ~"~"-1 `Z C-.~S~~~31 ' 2(~ ~ 1. L:11~A ~- oC ~' TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional). ~~=-~..~.,.Iv '~l ~~~~. 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: I~,S'PEC~FiC jLOB-BY I~St1E N~ ~ ~~ ~^ ^ ~l l gY~1 ~ ~G?~ ~S~ E a1 I ~C ~~~. Issue to be lobbied Descnbe m detail i~ Coll IY~S ' 1v ~- U'~~ ~~.1 ~~~~~t~ . ~,~, ( ) 3. I n. :CITY<AGENCIES/LND~UIDUALS TO~BEyL~BB~ED,:'Pursuantto City Code Section 2-482(g) include ~3 ~ ~.~,,,,~ ,. _ ...z ... .. ... ... :. 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 . personnel' commencement. of service with the City to the present date, stating the .general nature of . he subject contractual relation. A Full Name of Individual Title B) An Financial, Familial or Professional Relationship ~' ~' ~ • l~ar~~. ~~ 1;3 '6 ~ C~ ~ 1~3~ o ~ U~ ~' 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": ^ Yes o: Are ou lobb in on a resent or endin bid for nods a ui ment 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": ^_Yes L~ No: Are Vou lobbvina on a nendina annlicatien fnr a Dpvpinnmpnt er,~pp.,,o.,+ •.,a*ti ttie ~:~„ ~~ `' application for change of zoning map designation or chancre 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 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, .shelf not be required to pay any. registration fees. Yes ~ ^ No: Are ou re resentin a not-for- rofit co oration or enti without s ecial com ensation or reimbursement. V. SIGNATURE UNDER OATH: ' ON FEBRUARY 28th OF EACH YEAR, EACH .LOBBYIST SHALL SUBMIT. TO -THE CITY. CLERK A SIGNED STATEMENT .UNDER OATH. L!$TING 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 COMPENSATION DURING THE REPORTING PERIOD. ` Signature of Lobbyist 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 iri Section 2-482 of the .Miami Beach City Code and,~all reporting requirements. < ~ Signature of Lobbyist: . :Signature of Principal/Client: ' VI. LOBBYIST IDENTIFICATION: IDENTIFICATION: ~. D ~- .. ~ - ~p -~~ Z~ O ~17~ l50o J.5 ~ d - ~- ~ ~-- ~ Produced ID ~~ o ~ Produced ID ~ ~ N = Form of Identification Form of Identification zo~~ _3 a ; ¢ ~ ^ Personally known (Lobbyist) ^ Personally known (Principal ~ `,pti~~~'tR~~~ IvABEL ~RTCHELI ~v'ni vi o ~l '' ~~ +: t`Y1Y Cl"Ir~ ;MSS;GN ;# GD 879891 ~ ~ . ~-~~.'~-- ~ ° E~i'IF/S'» S: April 13, 2013 ~ g _ .. 1. SIGNATURE AND STAMP OF NOTARY: v,3 ~ X ~ `st;~`~` i3o~+ued Tt~ru Notary Public UnderwritarE w ~ ate of Florida, County of Miami-Dade State of Florida, County ofMiami-Dade ~ worn nd subscribed for me Sworn nd subscrib befgra me ;~~ • •°~~; his day of 2010 This day G T". , 2 '.~N*~BtP.`` _ '"""'`` ignature f Public ry -State of Florida Signature ublic N -State of Florida . f Notariz ion of Lobbyist's ignature. Notarizat' n of Principal's signature ~b~'`o~",i~l~ 0 TO BE COMPLETED BY .CITY CLERK'S .STAFF ONLY ,. Annual Registration fee: ]Yes [ ] No Amount Paid $ MCR # """-- Date Paid Lobbyist Registration Fonm received and verified by: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form 2010.doc / Revised 05/05/2010 ~~~~~ , City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityClerk@miamibeachfl.gov Tel: 305.673.7411. ,Fax: 305.673.7254 LO~~YIST Na41V1E: ~~~ ~ ~ ~-- I understand that no later than February 28th of each ~/e®r, I must file the following form., .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 and Compensation 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. Signature: Date: ., .. Revised 09/24/2010 -REP r F:\CLERILC)BBYIST\Expenditurt; ~'~~ DisU~los~r~ ~urrr Itr.ac:t, We are committed to providing excellent public service and safety to a!! who live, work, and play in our vibrant, tropical, historic community,