Eric T. Slazyk - Karim Duque I A A I B E,
City of Miami Beach Office of the City Clerk C//-,
1700 Convention Center Drive, Miami Beach, FL 33139 rt 1 �- ply
LOBBYIST REGISTRATION FORM - 16
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourdge the passage, defeat pr
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..
� •Z�[ I 1E_=_1tz(C 1
NAME OF LOBBYIST: (Last) (First) (M.1)
'I ;Z� IN C v►210 . 2,0) . 1 ,�r~,�w i-' -*love
BUSINESS NAME AND ADDRESS ( umber and Street) (City (State) (Zip Code)
e'5- 32 - <�>la c15-f -43-2 - &90 e aml ogo 4 U.=F-
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
L LOBBYIST RETAINED BY:
NAME OF PRINCIPALICLIE T:
�w ;a2_ 7 54ikt- 15I_ Po t-t ra"� 13CI4 F1
BUST ESS AME AND AD RES,$ (Number and Street) (City) (State) (Zip Code)
)T- S4 g52a
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 INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
u.SPECIFIC LOBBY ISSUE: -7
V>v-rzt cv N��=. 1--co v���'�c.�To►� F'��- �rr��2 '�35�� �I�4`,` . u�S'• F�
Issue to be lobbied(Describe in detail):
III.CITY AGENCIES/INDIVIDUALS 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
commencement of service with the city to the present date,stating the eneral 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
Se c ' L<11 vS
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
C
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required)
T'
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): E�
(Required). L'2ty 4<<l`� qn Hh (' 3,J_s'
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":
AE 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 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
D lopment Issues":
€Yes(€ N • Are you lobbying on a pending application for a Development Agreement with the CRY 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.
Ye €No. Are Vou representing a not-for-profit corporation or entitV 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 REMVIED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EON l9rTH11RE HAVE BEEN N_Q EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature of
I do solemnly swear that all of the for of g acts are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Bea Cit de and all reporting re uirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
€ Produced ID rL Ill.W 54 2 -Al Fr'51 3 0 € Produced ID
Form of Identification Form of Identification
€
Personally nown (Lobbyist) � *
ISABEL SATCHELL
y y ) *01 ; MY COMMISSION#DD 879891 4E Personally known(Principal
EXPIRES:A)hl 13,2013 ISABEL SATCHEII
VII. SIGNATURE AND STAMP OF N P- ;A..�at`'
Q;:•' Bonded Thn:Notary Public Underwriter ,=q: COMMISSION#DD 70131
t t P rR NotaryPPubI Underv+hers
%V.
State of Florida, County of Miami-Dade State of Florida, County o ]',tr5ade
Sworn to ano,subscribed before me Sworn nd subscribed e
This ^�� day of 201 This day of 011
Signature f Public N to - tate of Florida Signature of P blic Nota ate of Florida
Notarizat n of Lobbyist's signature Notarization f Princi s signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ Yes[ ]No Amount Paid$ MCR# Dat Paid
Lobbyist Registration Form received and verified by:
FACLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
C =orm.doc Revised 1/11/2011 MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeochfl.gov
CITY CLERK Office CiyClerk @miamibeachfl.gov
Tel: 305.673.741 1 , Fax: 305.673.7254
LOBBYIST NAME: ��)L `�• S�- Z.�f ��
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.
Pursuant to Section 2-485 (d), the City Clerk shall notify any lobbyist (or principal) who fails to
timely file a Statement and in addition to any other penalties which may be imposed as
provided in Section 2-485. 1 , a fine of $50.00 a day shall be assessed for all Statement(s)
filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on
Ethics and Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the
assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30th, 2012, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Mi de ounty Commission on Ethics and Public Trust.
2 , l2.
Signature: Date:
FACLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc