Javier E. Fernandez - 1747 Bay Road Properties, LLC A , #i
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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 2004 -3435.
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ME OF LOBBYIST: (Last) (First) (M.I) s
mi44( t$3i$i
B SINE S NAME N ADD S f (Number and Street) City) (Stat (Zdp Code)
*- 4 - 3 4 L i 5' fa? c T JF de
TELEPHONE NUMBER: F UMBER: EMAIL: 4 gg J - ,» . CCY"
Please notify this office if your contact information changes: address, phone, or e-mail address.
I. LOBBYIST RETAINED BY:
1 3 L a 1 1 PrO WOP ert e r r II C
NAME OF PRINCIPAL/ LI NT: •
my , ._ gcuie,i4d
BUSINESS NAME AND i "` / - 3444 - . an_s_, e et) (City) (State) (Zip Code)
TELEPHONE NUMBER: , FAX NUMBER: (Optional) EMAIL: (Optional)
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 INTREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
//SPEC/ IC LOB . Y I S . :. E r
1 ] 9 ' m t r Th vi sr
Issue to be lobbied (Describe in detail):
111 CITY GENC ES I DI I L$ TO E L OBBIED
Pursuant to City Code Section 2- 482(a)(4) include the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's
commencement of service with the city to the present date, stating the general nature of the subject contractual relationship.
Sec 2- 482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES NO
title of person to be lobbied
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Pursuant to City Code Section 2 -482(g) Every registrant shall be required to state the extent of any business, financial, familial or professional
relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner or city personnel who is
sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2- 482(g) Any Financial, Familial or Professional Relationship 331,4J0 ,'831 J A113
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IV, DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
O '
A) LOBBYIST DISCLOSURE: ( '
B) PRINCIPAL'S DISCLOSINIE . (OF LOBBYIST COMPENSATION)* 4 0 ,„„ 0 t e I
b d.Alull Ilk.
The Bowing information must be answered:
1) Pursuant to Miami Code Section 2 Entitled 'Prohibited Campaign Corifrth� By Lobbyists On Pr
lame;
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2) Pursuant to Miami Beach City Code 2-90 Erb*Prohibited Campaign Contributions By Lobbyists t Real Estate
Development Ids':
0 Y vim fobtoina on # nenOst smoNcotign for k VV 19ortiont Am qty or application for
a , , # P J i f i i . 9 I. ry , - ,,. .. , !}y IL : S s F -tt .; k. -. nd _.l. A -
3) Pursuant to ; Beach City Code 2484 (h) Any person (except from the detni ion . ' as set forth in
Section 2-481 above) who special
- • - d motion , or reirnbursement the 'appearance, whether *, or _ • . ,. express support or opposition to any
ite , shall register with the clerk as required by this section but, ' shall not be required to pay any registration fees.
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v. SIGNATURE UNDER OATH:
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• - I. _4''.1. # -.... ' .i- . . .�iA.i : 3..�.11� lIslj lit. - �.i it; :- : jj s cP 1
TIE PRECEDIKSALKENAR - r ,
i do solemnly sweat that all the foregoing facts are true and - hand that I have read or afam with provisions contained .
in Section 2-482 :of the Beach City Code and all reporting requirements.
Signature oIt
Signature of 4 „ 1- -, _... , •
V . LOBBYIST FICA PRINCVAL IIYIENT FICATION:
0 Produced ID 0 Produced ID
form of Idelltiftlidien Fes-
CI Pew known Lob is
� by ) Erresonally known (Prkscipal)
r
. SIGNATURE AND STAMP OF NOTARY:
State of Florida of Miami-Dade State Court of 11 e
:c� Vie, ;
Sworn to and subscribed before Swom aAcl subscribed before. me
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4igrture Public tate of Fl
oea .._ - Public - State
.... - .. - _ ��._ ... _ ...: ... Signature. �.�� Notary :” r of Florida :
' � on orprIncloara, signature
, TO BE . CITY CLERK'S STAFF ONLY _ w ...,, e 1 i
Annual Registration f# t
Lobbyist - hill" `' . •
l‘ : A.. YI rte' n'utJ rra ..l ,,24.1.4t
NOTARY FUBLIC -STATE OF FLORIDA
( e:" , Beth Barash NOTARY F IJC•STATE OF FLORIDA
, � - + Commission #D1)786252 4 % Beth Barash
. . .
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� � Expires: JUNE 24, 2012 � �� � � � .� - ,. � C ommission # DD7 C a:.�: �:
s�xo Tin ATLANTIC BONDING CO,, INC. 1 Expires: JUNE 24,
BONDED THEY ATLANTIC BONDING Ct ., ..