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--.--z.„...----. , City of Miami Beach:Office of the City Clerk
1700 Convention'Center Drive, Miami Beach, FL 33139'-
'. ,.t_ •-,-,' LOBBYIST REGISTRATIOMFORM ' . w.,
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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 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)
(9►05) 434--633e C S �c2-S292 y. Qekee„c�o �N9,c
TELEPH
NE NUMBER: FAX NUM EMAIL.
Please notify this office if your contact information changes:address,phone, ore-mail address. . .
I. LOBBYIST RETAINED BY: c'As\ 1 o A`rr J
NAME OF PRINCIPAUCLIENT
(4 Z 4 $430Th CArkehd 01(1A0' tiMAAA 1 1(21iti& fk-• 3 3(4"1 — 2¢14
CBUSINESS S NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)/"�
U:6 e� - �� 2 to'!.� V An cani
TELEP NE 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 INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST
Il.SPECIFIC LOBBY ISSUE: .' 9G� ' v og pm'b ' CY�t-T1 S%1I /
c9QZ((4.4 i2.€31 r ek SO'c -F ' OeS1.Co 0' 'y &(WI T2 iA-(`
Issue to be lobbied(Describe in detail): ( ^s , i 'p- , i 61.-k-C AAA( �' i c•I+
iii.CITY AGENCIES/INDNIDUALS;TO 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
r 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
' , r2,' AiyA ., ,
1 Pursuant to City Code Section'2-482(g)Every registrant shall be required to state the extent stilt*u in lss,.financial,familial or professional
relationship,or other relationship giving rise to an,appearance of an impropriety,with any current city-comimsiiin, r ity 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 p7 t z '°I kiv Z
.--19 1
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I.
IV DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR ,
OTHER)
A) LOBBYIST (,�
DISCLOSE.1( fired) ` + 4"-A.-q � ,
( Puired) f}�'S DI�S�C, '• (OF L� OBE3YJ�ST�CkMpE T O -5. r� O n /�f(�,2 T( efts :41
(Required). ��Q�. .. /��./,�/11,1`j ' T �� "C�Jve� \_��lc�.�x�(cs.�`p� efts]J
The following informal••t t tfe answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Issues"
❑ Yes o: Are you lobbying on a present or pending bid for goods, equipment or services, or on a present or pending
7 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 .
• r •
❑Yes / No: Are you 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.
0 Yes 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 C SATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SH I �a - EN`F THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD/ „
_____4
Signature of Lobbyist
I do solemnly swear that a of t.,- "or-:oin• fact are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Mia • ::ch .ity 1.- • - reporting requirements.
vir f"
Signature of Lobbyist: \
Signature of Principal/Client: r� . 0
VI. LOBBYIST.IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID C 1 C71 -790 54)-Pbg-0 E-Produced ID Dfivc a LI «",S 5
Form of Identification Form of Identification
❑ Personally known (Lobbyis "" LA siZGATEGUI
y ISpgELSATCNt:U ❑ Personal y,l a {PriW�i j
?` Y.�ryk tflYCOMMISSION#DD879891 ''` •.•- MY COMMISSION#EE130197
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VII. SIGNATURE AND STAMP ., ,, Y: EXPIRES'
uWtcunderwriters - '% EXPIRES September 14,2015
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State of Florida, County of Miami-Dade` State of Flori un y o lami-Dade
Sworn to and subscribed before me Sworn and subscribed before me
This day of_>,!o,� �, 2011 This '7 day of, ' 4L , 2011
IA (L—\,---() 4 01 ,
Signa ure • Public Notary—State of Florida Signature r=ublic Notary—State of Florida
Notarization of Lobbyist's signature Notariz. ion.of Principal's signature
TO BE COMPLETED BY CITY CLERK' 'ST`5 �N Y ..
AnnuaIRegistration•fee: [ :]`Yes;[ ']No .Amount:Paidi$ V.°C- CR4t / Date Paid /o2 ?Z-' J/
Lobbyist:Registration Form received and.verified:by. S ' LI " /Li�r-,
F:\CLER\SALL\aFORMS\LOBBYIST FORMS`Lobbyist Annual Registration Form.cloc Revised 1/11/2011
9
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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
LOBBYIST NAME: /V4 CA
I understand that no later than February 28th of each year, 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.
A -.141
41r ,
l(72/1( —
Signature: Date: