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Diana Pelaez - Playa de Oro, LLC o no , . moo M1AM1BEACH 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. PE,LA62,_ :1) /A- L_)/4- NAME OF LOBBYIST: (Last) (First) (M.I) ki4i-p4 ©t_ C,'r2�� L f < -- )SI /1415.h.),-,f0 A -ve, n4 2 64c'N ft 3 3 BUSINESS MME AND ADDRESS (Number and Street) (City) (State) (Zip Code) �C`` • - ,3c 7 - t- 3 Y D ,#1 ,t,,. 414/2(4 - /u4/c , (e9•'7 TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: NAME OF PRINCIPAUCLIENT: t_ AI c CliC) tic. 7 1 it( Lam. /�ir4 !-���'�: f°L'� �ile4c /_. 336 7 BUSINESS ME AND DDR (Number and Street) -) ) 4 7 . 7 - - 33 y (City) (State) , 7 � � �� � � I CI�.� � , of ed.' TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) FIN out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: J C)/2C i - ' / • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPO ION, PARTNERSHIP OR TRUSTr �• - &2tj,G Zi4t4L Ju , 6 d loS ?iz , )2e A C to i urv 11 51, - e r n2 cz/( i S sle. 1Y ?S / 7)7e.ci*c&,.' .�l ke fi Issue to be Lobbied (Describe in detail): 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 Alt Ci 1:0 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 dty 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 '47 '7 A113 10 's ;id Gz ddV t IOZ (.1 A 1 3 a 519 I IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) S A L i B) PRINCIPALS DISCLOSURE (OF LOBBYIST COMPENSATI N): � (Required). -t'C r4 /Z. y The following information must be answered: r 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues Yes L7 No: Are you lobbying on a n or pending bid for equipment or services. or on resent or n pre�e t Q qe dl a b d o goods. a A G Ae dlnsat award for goods, equipment or serviceZ 2) Pursuant to Miami Beach City Code 2 -490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Develo ent Issues ": D Yes No: Are vou lobbying on a pending application for a Development Agreement with the City or 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 a not- 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. U Yes De ‘Are vou representing a not - for - profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON FEBRUARY 28th OF EACH YEAR. E&CH LOBBYIST SHALL SUB TO THE CI _CLARK • SIGNED STATEMENT UNDER • ATH LI TIN L • BBY NG E • NDITURE A 1 LL AS C!_)1,1 • 1 • - D IN - • .. IAMI BEA H • ; ' THE PRECEDING CALENDAR YEAR. A TAT .. ENT SH • BE Fl I1 , • 1 3 . NO EXPEND ii. ; S OR COMPENSATION DURING THE REPORTING PERIOD. ANIIIIIII ,, / S . - of L • .'.'' 1 do solemnly l o - �,_ - �-" �. : « � . ,+ . Y swear that al.� f the • reg =r t have read or am familiar with the provisions contained in Section 2-482 of the Mi�(`mi B ch Ci • • e - •,-, 1 • • ing , r r,(f , : Signature of Lobbyist / 1 / y , 41111111/�.I /i ce"" Signature of Principal - / / //, VI. LOBBYIST IDENTIFI N 51 Ff. �� PRINCIPAL IDENTIFICATION: P; SW Produced ID A t ; �_ ❑ Produced ID Form of Identifi i on Form of Identification ❑ Personally known (Lobbyist) ❑ Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florid , my of Miami - 0 : de State of Florida, County of Miami -Dade Swom • . • • su•. 45: •�+ : ore MISSHKA LOPEZ wom and subscribed before me This & A i d : of .-.41/11.,..._/ 2011 �� u ,,,,,,,,,. This day of , 2011 v � ` Comm#/ DD0887812 —� r � -•� = . Expires 5/17/2013 -'• ' of "u*tic of -ry - tate of • '• * Uk-:' r of Public Notary - State of Florida t ' , / ia�` Florida Notary No rization of Lobbyists signature ",s s ................®G.......... on of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY 87812' , , .4��'�� ��� Comm# C1A0 & r' : z Expires 5/17/2013 L-7(2_2==iy/ ,. � •�x ,Inc ,; arti?�` Florida Notary Assn., : �a:wti es---c2,0 - -22,..ei. 1 MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachH.gov CITY CLERK Office CityClerk @miamibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 I r � LOBBYIST NAME: b I N �4 ` e 2-- I understand that no later than February 28th of each my, 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, . .ce an issue I have r= •' - ed to lobby on has been resolved, I am required to imme. 'ately otify the Ci ' erk's Offic - of lobbyist withdrawal in writing. 0Y 01 / ' re: Date: