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Gonzalo Alberto Gayoso - Valentina Phillips Zagor
MIAMI BEACH 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. GAYOSO GONZAT,O ALBERTO NAME OF LOBBYIST: (Last) (First) (M.I) GLANTZ & GLANTZ, PA, 7951 SW 6 Strut, Plantation, FL 33324 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 954 -424 -1200 954 - 424 -1206 TELEPHONE NUMBER: FAX NUMBER: EMAIL: P /ease notify this office if your contact information changes: address, phone,; or e-mail address.." LOBBYIST RETAINED BY: VALENTINA PHILLIPS ZAGOR NAME OF PRINCIPAUCLIENT: 3425 COLLINS AVENUE, #603, NIAASI BEACH, FLORIDA 33140 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) TELEPHOgE NUB: 1 FAX NUMBER: (Opticnat) Fi olit this section if principal is a Corporation, Partnership or Trust [Section 2 -482 (c)] EMAIL: (Optional) • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: N/A • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: uSPECIFIC LOBBYISSUE"S�`�� -- k_(,tq)i 3425 Collins Avenue, Miami Beach, Florida I Issue to be lobbied (Describe in detail): ul. CITY AGENCIES /INDIVIDUALS TO, BE Q'OBB ED: 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 title of person to be lobbied __. �' -J-14, ,,r11,1-1 Contractual Relationship (Explain) YES NO Cl'IA 0fAA 1 111,ilt 1 A0 tL i s b1 N - 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. l r� t ; x , , •z , , , Sec 2- 482(g) Any Financial, Familial or Professional Relationship __. �' -J-14, ,,r11,1-1 'v A.1.. t �' NCI© fir' 50 :1 Wd L? s E F : \CLER \$ALL \aFORMS\LOBBYIST FORMS\Lobbyist Regisrration Form.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) HOURLY AT $225/hr B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). HOURLY AT $225/hr 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 ": € 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 Development Issues ": €Yes € Na:i Are you Iobbvinq 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. € 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 CITP6 CLERK A SI ED TATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE ITY O MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED E IF HE E HAVE = EEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIO Signa rO obbyist I do solemnly swear tha of th foregoing fay: s are true and c.rrect an. at I f ave read or am familiar with the provisions contained in Section 2 -482 of the M :m , h City Cod and all iep- ting quirements. Signature of Lobbyist: Signature of Principal /Client: VI. LOBBYIST IDENTIFICATION: € Produced ID Pi' 1).L- ® 2H4'13-‘,0 Form Form of Identification € Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami -Dade Sworn to and subscribed before me This fir% day of �'Mn- 41 ;.291-]2 Y PUBLIC -STATE OF FLORIDA nature of Public Notary — S -tef Fl • ' Benveniste Notarization of Lobbyist's sigij b.f eammission #DD836846 ,. Expires: NOV. 11, 2012 Tan An acouvc a',aD BY C� fMCR # PRINCIPAL IDENTIFICATION: € Produced ID Form of Identification € Personally known (Principal) State of Florida, County of Miami -Dade Sworn and subscribed before me This day of , 2011 Signature of Public Notary — State of Florida Notarization of Principal's signature CITY CLERK'S STAFF ONLY Annual Registration fee: Yes [ ] No Amount Paid $ Lobbyist Registration For received and verified by: F: \CLER \$ALL \aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc 03/26/2012 16:27 2112400321 CITYLINE PHARMACY • DiSCLOSUilE OF TERMS AND AMOUNTS OP LOBBYIST exaMPENSA11ON (DISCLOSE WHETHER HOURLY, FLAT I ATE 011 oTHERk At LO$eWST DISCLOSURE: (Required) B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION). (Required). The following Information must be answered; 1) Pursuant to Miarni Maeit City Cade Seaton 2-488 Entitled 'Prohibited Campaign Cantn'butlons By Lobbyists On Procurement issues": Y • = n-tit.a t! for . tads 72 UI• _It or1 award for reads. AduiDmerti tin eeruite? 2) Pursuant to Miami Beach Oily Code 2-490 Entitled°Prohlblted Campaign Contributions By Lobbyists On Real Estate Devetopiytent Issues ": 'EYss €1D: Art lobbyrinQ o a pend' q afltilttv3tlon fnr a d 0joprstent ACreemartt with ha Cliv_Or aapIICaBon for OJtango ofztlr'rlrta sn in 'n or cha to tine Citds Ptsture g t Lanea Adam? s) Pursuant to Miami Bah Clly Cods 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 opp09ition to any item, shalt register with tho clerk as required by this section but. shall not be required to pay any registration fees. €Yes €N-oyAre you rearesentina amat- for- nrafitaarnaratty or sntlt without 9UeCtai Cdrmpensittion or . irnbrfr g9rrt6nL . V. SIGNATURE UNDER OATft • 1 .1.1ti. •B- t_1 ■: A SI NED STATE T i • ER I. 1 Signature of Lobbyist • I do solemnly swear that all of the foregoing facts are true and correct and that i have read or am familiar with the provisions contained in Section 2 -482 of the Mlaml Beach City Code and all reporting requirements. Signature of hobbyist: Signature of Princip2UCilent,,X .- Vl. LOBBYIST IDENTIFICATION: Vit. Produced ID Form of kientification € Personally known (Lobbyist) SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami •Dade Swo to - nd SULdCitbe Thl -., - day of �E y`+01. ‘25W14-4? Signature of Public Notary —State of Florida Notarization of toll t'¢ signature PRINCIPAL lb ENTWICATIONt ' v Produced ID Form of Identification * Personally known (Principal) State of Florida. County of Miami -Dade Sworn and subscribed before me mit . day of 2011 Signature of Public Notary —State of Florida Notarization of arim:oat's signature To EtE COMPLETED BY crry CLERK'S STAPP ONLY AnrftaaE Regiatrattan free: `Yes Kfo::!Artwunt. • ] •� ,�ucR:�•'� •• •:.:.::., Date amt • Lobbyist RaJstial1on Form iecahyed aitsCv9tlfled icy - P: ICLER1SALLlaFORMS\LOBBYIST FORMSlobbyiat Registration Form.doc PAGE 01 °orm.doc'` Revised 1/11/2011 MIAMIBEACH 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: GONZALO ALBERTO GAYOSO 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=4E6.1, a fine of $50.00 a day shall be assessed for all Statement(s) filed after the clue 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 er notification. Any lobby automatic appe t ho ils to fiI the required Statement by April 30th, 2012, shall be usp -nded from bbying until . n =s are paid, unless the fine has been e .' iami -Dade C unty Comm si +n on ics and Public Trust. F: \CLER\$ALL \aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc Date: