Christian R. Schwartz - Cori Rice 0,
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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 :erm 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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NAME OF LOBBYIST: (Last) (First) (M I)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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TELEPHONE NUMBER: FAX NUMBER. EMAIL
Please notify this office if your contact in rormation changes: address, phone, or e-mail address.
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT.
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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TELEPHONE NUMBER. FAX NUMBER. (Optional) { EMAIL. (Optional)
FIB out this section if principal is a Corporation, Partnership or Trust (Section 2-482 (c)j
• 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:
II.SPECIFIC LOBBY ISSUE: ##� c
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Issue to be lobbied (Describe in detail)
III. CITY AGENCIES /INDIVIDUALS TD BE LOBBIED:
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 Individt.al 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 regist-ant shall be required to state the extent of any business, financial, familial or professional
relationship, or other relationship giving rise to an i ppearance of an impropriety, With -krl fct 'reat,egyrcpn)mjssi 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 z2- £ Wd
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IV, DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE. (Required) f &4 W
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COM.. NSATION)J.
(Required), tv'� P r 1) I T(Ot4d •v L
The following information must be answered:
1) Pursuant to Miami Beach City Code Sec tion 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement
Issues ":
3Y Yes ❑ No: Are you lobbying on a present or pending 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 -4 )0 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues ".
❑ Yes [V No: Are you lobbying on a pending application for a Development Agreement with the City or application for
change of zoning map design Ilion 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 app'ars 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 reqLired by this section but, shall not be required to pay any registration fees.
❑ Yes L< No: Are you representing a not - for - profit corporation or entity without special compensation 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, LISTING 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 FERIOD.
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Signature of Lobbyl
I do solemnly swear that all of the foregoing facts are true and correct a t I have rea or am familiar with the provisions contained
in Section 2-482 of the Miami Beach City Code aid all reporting requirements --
Signature of Lobbyist:
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Signature of Principal /Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID '' ❑ Produced ID
Form of Identification Form of Identification
Personally known (Lobbyist) ❑ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami -Dade t!" ROBERTO A GONZALEZS ate of Florida, County of Miami -Dade
Sworn to and subscribed before me :'?�• ' >E MY COMMISSION # DD80653'6 orn and subscribed before me
This 3( 5f day of YV)a , 2011 �++!a,S EXPIRES July 16, 2012 T is day of , 2011
(407)398 - FlondallolarySarvice . com
Signatur- o" : is Not — State of Florida Signature of Public Notary — State of Florida
Notariz. '.n • o• •gist's s'; ature Notarization of Principal's signature
•
TO BE COMPLETE. B CITY CLERK' _TAFF ONLY
Annual Registration fee: [ ] Yes [ ] No Amoun Paid S fif/ MCR # ATIGfi/'j Dat aid t
Lobbyist Registration Form received and verified by: i'/
F: \CLER \BALL \aFORMS \LOBBYIST FORMS Lobbyist An ival Registration Form.doc .N d Revised 1/11/ 011
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IV, DISCLOSURE OF TERMS AND AMOUN S OF LOBBYIST COMPENSATION (DISCL S E "b H THER H OURLY, FLATRATE OR 1
PM OTHER): ZUI I JUN 22 Phi I2'3 (
A) LOBBYIST DISCLOSURE: (Required) i
ND Ift�D(r cud, 'c/.- tomfEr -5.A
CITY CLERK'S OFF ICE
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST C. MP NSATION ): , . � y �
(Required). tJ(1 /t? 17(O t . 70- ('Pkr 17 h — t—. 1"-J I
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The following information must be answer d:
1) Pursuant to Miami Beach City Code ection 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement
n� Issues ":
LV' Yes ❑ No: Are you lobbying on a pre-ent or pending bid for goods, equipment or services, or on a present or pending
award for goods, equlpme t or service?
2) Pursuant to Miami Beach City Code •-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues ":
❑ Yes 1 No: Are you lobbying on a pe ding application for a Development Agreement with the City or application for
change of zoning map des . nation or change to the City's Future Land Use Map?
3) Pursuant to Miami Beach City Code 0 -484 (h) Any person (except those exempt from the definition of "lobbyist' as set forth in
Section 2-481 above) who only - ppears as a representative of a not - for- profit corporation or entity without special
compensation or reimbursement fo the appearance, whether direct, or Indirect, to express support of or opposition to any
item, shall register with the clerk as - quired by this section but, shall not be required to pay any registration fees,
❑ Yes (9 No; Are you representing a no for - profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th OF EACH YEAR, EA' H LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITUR S, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR,
THE PRECEDING CALENDAR YEAR. A S ATEMENT SHALL BE FILED EVEN iF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTI G PERIOD.
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Signature of Lobbyis
I do solemnly swear that all of the foregoing acts are true and correct an t i have rea or am familiar with the provisions contained
in Section 2 -482 of the Miami Beach City Co and all reporting requirements
Signature of Lobbyist: ,..i..../...
Signature of Principal /Client: t
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION;
t'Produced ID f,fUyNs 0 Produced ID
1 Form of Identific- ion Form of Identification
Personally known (Lobbyist) Personally ho. wrj `YiiloparBERTO A GONZALEZ
.; ' MY COMMISSION # DD80653
I
I VII. SIGNATURE AND STAMP OF N • ARY: EXPIRES July 16. 2012
i '
ROBERT A GONZALEZ (401) 399.O1r' FlondalloterySemce . com
State of Florida, County of Miami -Dade
I t} Sate of Florida, . • 'RarerDade
4 Sworn to and subscribed befor m -rE ° MY COMMISSION # DD806535 Om and subscrit�d before me
1 This 3( S'F day III
A , 2011 - - EXPIRES July 16, 2012 T its 15f(-day, J12v'LQ_. 2011
1 1
r•) is,,,, a FIoidnNotary Service con,
• I Signatur• a 7IA ic Not. — State of Florid. Signature • Public u� of Flonda
1 Notarize • n . o.. gist's s 1. ature Notarization o - • n ature
1 0 BE COMPLETE. B CITY CLERK' _TAFF ONLY _
Annual Registration fee: ( ] Yes j ] No • ount Paid $ Air MCR# arfr I Dat_ 'aid 7
Lobbyist Registration Form received and verl ed by: ' Z�� r
F: \LEER \$ALL \a FORMS \LOBBYIST FORMS \Cobb ist Annual Registration Fnrm.tl oc r ' Revised 1/11/2011
al MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.mramrbeachfl gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305 673 7411 , Fax. 305.673.7254
LOBBYIST NAME: 0_ f�! CTk �
I understand that no later than February 28th of each year, I must file the following
form, pursuant to Section 2 -435 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 ! have registered to lobby on has been resolved, I am required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
I Signature: Date: I
I