Rene D. Gueits - Rene Gueits V
t I B
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL AyfEB _8 PA 12: 52
LOBBYIST REGISTRATION FORM I 1,L L!5, `j �;;-L I
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 acti n, decision or recommendation that foreseeably will be heard or reviewed by the city
commission, or a city board or committee. e term specifically includes the principal as well as any employee engaged in lobbying
activities. The term"Lobbyist " as speci is exclusions. Ple e r ter to Ordinance 200 35.
JCt
NAME OF LOBBY T: (Last) irst) (M.1)
o
BUSINESS NAME AND ADDRESS (Number and Street) (City) te)` (Zip Code)
e t �� � c� tY�1� Y,4a)xo m
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information change : address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
NAUF,GF P INCIPA TENT:
BUSI E N D S (Number. Sit) (Ci
i4l li Zi Cod��
i
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust ction 2-482(c)]
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: (►l' �'.
• IDENTIFY ALL PERSONS HOLqVP,DIRECT R I I E_CTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY ISSUE:
Issue to be lobbied(Describe in detail): M8
I
III.CITY AG ENC.IESANDIVIDUALS TO BE LOBBIED: c !Q
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 nr 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 persAn to be 1 bbied
VCAr y
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:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
s 2l
4
i
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
ZSS es
_Yes_ 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 Section 2490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Dev lopment Issues":
_Yes o: 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 Section 2-482(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
ompensation 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 ou s ec nsation or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR EACH LOBE ST SHALL SUBMIT TO THE CITY CLERK A SIGNED ST TEMENT UNDER
OATH LISTING LOBBYING EXPENDITURES AS WEh AS COMPENSATION RECEIVED IN THE CITY OF IAMI BEACH FOR
THE PRECEDING CALENDAR! S BE FILED EVEN IF THERE HAVE BEENX10 EXPENDITURES OR
COMPENSATION DURI THE REPORTING PERIOD.
ignature
I do solemnly swear that all of the foreg facts are true and orrect d that I have r d am familiar with the provisions contained
in Section 2-482 of the Miami Beach City C and all reporti r ements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFIC PRINCIPAL IDENTIFICATION:
Produced ID�3�0�7 - roduced ID IZ b I/Vo!s L ce.,Js
�3
Form of Iden cation �� Form of Identification
Personally known(Lobbyist) qt. °•.`�'�c Personally known (Principal)
C moo` �� o
VII. SIGNATURE AND STAMP OF NOTARY: ��� c��'o`� a(voc
�°QQ ,`c'o
State of Florida,County of Miami-Dade of Florida, County of Miami-Dade
Sworn to-and subscribed ore me ; #• �o Sworn V subscrib d efore me cd4 4This day f ," ,2012 =�' is-� y f U 2012
�?
4_1
}
ago
Signa e of Public otary-State of Florida Signat re of Publi fary-State of Florida
Notari tion of Lobbyist's signature Notari at of P inci al's signature
-" :K�
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration-fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid
Lobbyist Registration Form received and verified by:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
a
F:�CLE1 iistration Form.doc Revised 04/27/2012
_% F "" u
AIANAlr
a
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granada, City Clerk CityClerk@miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: r � .
I understand that no later than February 28 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, or I am no
longer lobbying on that issue or for that principal, 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 thics and Public Trust of the failure of a lobbyist(or principal)
to file tementor pay the essed fines after notification.
Any lobbyist, who fails to file the re ired Statement by April 30th, 2012, shall be
auto tically suspended from lobbyin until all fines are paid, unless the fine has been
appeals o the Miami-Dade Coun ommission on Ethics and Public rust.
Signa - a
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc