Ronald M. Bergeron, Sr. - Bergeron Land MIAM-1 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 2004-34355.
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NAME OF LOBBYIST: st) (First) (M.I)
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R ISIN S NAM AND ADDRESS (N ber and Str et) (City) (State) (2ip Code)
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TELEPHONE NUMBER: FAX NUMBER: E AIL:
Pleaseh"t thls office lf'your contacf Information changes:address,phone,or e-mail::address
I. LOBBYIST RETAINED BY:
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NAME P INCIPAUCLIENT:
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BU S N D AFL jj (Number and Street) f ity (State) • (Zi Code)
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TELEPHONE NUMBER: F NU ER:(Optional) EMAIL ptional)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-4J8�2(c)]
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: &0/44 Ac& 4 r-
• IDENTIFY ALL PERSONS H0,6DINQ, IRECTLY OR INDIRECTL ,A50/61)R MORE OWNERSHIP INTERFEST IN 5UCH C.QRPOF TIO
PARTNERSHIP OR TRUST: ,• /
II'J �Cti �6_E�+ �LO j$.SU !,
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Issue to be lobbied(Describe in detail):
f � TP� ;LOB iEIll CCLA � D E_ :
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
APA i
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. ti
Sec 2-482(g)Any Financial,Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST C PENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) AW G', lC A-45d 41
B) RINCIPAL'S DIS'LOSURE(OF LOBBYIST COMPENSAT ON): 15,
The following informa ion must be answered:
Pur Oant to Mimi Beach City Code Section 88 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Is ues":
Yes o: Are you lobb in on a resent or en in bid for good a ui ment or services or on a resent or pending
award for oods a ui ment or servic ?
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2 Pursuant to M' n} Beach City Code Section 2 90 Entitled"P hibited Campaign Contributions By Lobbyists On Real Estate
Development ssUes":
_ s No: Are o I bb in on a endin a licat on for a D veto meet Agreement with the City or a lication for
chan e f zonin ma desi nation or c an a to a City's Future Land Use Map?
3) ursuant t iami Beach City Code Section 2-4 (h) y rson(e ept those exempt from the definition of"lobbyist"as set
rth in S ction 2-481 above)who only appears s a presentative f a not-for-profit corporation or entity without special
c mpensati n or reimbursement for the appeara e, hether direct, indirect, to express support of or opposition to any
it m,shay ,egister with the clerk as required by this' tion but,shall not a required t ay any registration fees.
_YeXNo: Are u re resentin a not-for- rofit cor r ion or entit witho t s ecial m ensation or r mburseme
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V. SIGN T R ER OATH:
ON FEBRUAR 8 OF EACH YEA EACH LOB/YIS/,SHALL SUBMIT TO HE Cl Y CLERK A SIG D STAT ME T UNDER
OATH LISTINCA.QBBYING EXPEN ITURES AS WELL AS COMPENSATION REC IVED IN THE CI OF MIANI EACH FOR
THE PRECE G ALENDAR YEA A STATEMENT AL B ILED EN IF T ERI#HAVE BE NO EX E ITURES OR
COMPENSATION OURING THE REP RTING PERIOD. / //
ignat of ob t VV W
I do solemnly swear at all f t e fordgoing ifel t ue r ct nd hat I have read or am fam'iar with th prov' ions contained
in Section 2-482 of the Mia i B ach City Co in uir me
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Signa ture of Lobbyist:
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Signature of Principal/Client: U y M Tj
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICA ION:
_Produced ID _Produced ID
Form of identification Form of Identification
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�Ponall known(Lobbyist ti�t���[Irl��ll Personally known(Princi a D >i
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VII. SIGNATURE AND STAMP OI;�IOrp
.'� ,F� ��ebt�ary? f.State of Florida,County of Miami-Dac � J' * State of Florida,County of MiZIN-Pade �. °7° a _ ••.••••.���
Sworn to and subscri before me _*• e'•� :�_ Sworn and subscri��je fore Fp ` =•�M�81pN •
This�da of �� ,2(� NE�Q6419� O� This /� day of � aer 32 y?Da
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Signatur Publ c Notary—State of Flon •(•.•••.�cdc\\���� Signat a ublic Notary—State of Florida!!�;qTE OF s #EEOQ4i32
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STA. //!!11l161t�� s9 .
Notarization of Lobbyists signature Of 1111111t�1 Notarization of Principal's,signature os ' •• �
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY s��s/ �'�C••�•"••••••
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid /���! llljljljl 1 �
Lobbyist Registration Form received and verified by.
FijCLERX#ALL\sFORMSjLOBBYIST FORMS1Lobbylst Annual Registration Form.doc Revised 11/18/2013
F:ICLERI$ALL1aFORMSILOBBYIST FORMSILobbyist Registration Form.doc
d Y 1 IAMI BEAC H
city of Miami Booth, 1700 Convenliori Center Dive,Miami Beach,Florida 331`39,www.miamibeachh.9ov.
OW CLERK Office
Rofael-E.Granodo,City Clerk CityClerk @miamibeachfl:gov;
Tel:305.673.7411 ,Fax:305.673:7254 ;
LOBBYIST NAME:
1 understand that n later than February 28 of each year, I must file the following form,
pursuant to Secti n 2-485 of the Miami Beach City Code, with the City Clerk's Office for
all active lobbyi g issues.
1) L,OSSYI EXPEND TURF AND COMPENSATION FORM
Failure to fi these f rms on a timely basis will result in my name being transmitted to
the Miami- ade Co ty Commission on Ethics and for code violation evaluation.
In additio , once an issue I have registered to lobby on has been resolved, or I am no
longer to byin on that issue or for that principal, I am required to immediately notify
the City lerk' Office of lobbyist withdrawal in writing.
Pursua to n (d)o the City Clerk shall notify any lobbyist(or principal)who
fails to ly file a S . tement and In addition to any other penalties which may be
Imp o s provided In ection 2-485.1,a fine of$50.00 a day shall be assessed for all
S m t(s) filed after the due date. The City Clerk shall notify the Miami-Dade
ounty ommission on E thics and Puloic Trust of the failure of a lobbyist(or principal)
to file a Statement or p 3 y e asse ed fines after notification.
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Any I 4yist,who falls fi a the re Ired S tement by April 30,shall be automatically
9 nd"ed from lobbyi until all es a paid/unless the fine has been appealed to
la I-Dade Coun mmissi on E ics nd Public Trust.
Signa V �' Date
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FACLERULLIaFORMSILOBBYIST FORMSILobbyist Registration Form.doc