Jose F. Diaz - Miami Beach Tennis Management, LLC /v.
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City of K8imrni Beach Office of the City Clerk
1700 Convention Center Dhma, Miami Beaoh, FL 33138
LOBBYIST REGISTRATION FORM
Lobbyist means all penoonamnp|uvod or retained, whether paid or not, by principal who seeks tn encourage the p0000go, defeat or
modification of any uod|nan'oo, noou|mion, action or decision of any commissioner; any action, deoiomn, 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 pmoeou on such octinn, decision or recommendation that *onoaeoab|ywill be haon1 or reviewed by the city
cnmmioa|on, or city board or committee. The »ann specifically includes the principal as well as any employee engaged in lobbying
activities. The term^Lobby|mtm" has specific exclusions. Please refer to Ordinance uou4'm435.
t)i�-z .Tose r,
NAME OF LOBBYIST: (Last) (First) (M.1)
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
� 80 . /
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office/fyour contact information changes:address,phone, or e-mail address.
/. LOBBYIST RETAINED BY:
7ME OF PRINCIPALJCLIIN�., _T
7USINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
7ELEPHONE 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:
ii.SPECIFIC LOBBY ISSUE:
Issue to be legied(Describe in detail):
III.CITY AG ENCXES/I N DUVUDUALS 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) wux said city commissioner or personnel from 12 months preceding such pomnn*
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
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 orcity personnel who is
sought ovum lobbied um identified pn the lobbyist registration form filed.
Sec 2-482(g)Any Financial,Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) 4 33 OD per
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): ��� OO
(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
/Yes Issues":_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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_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 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
compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any
i m, shall register with the clerk as required by this section but, shall not be required to pay any registration fees.
Yes
Z. Are you representing a not-for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signatu a 0 yist
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 Miami Beach City Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client: '
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID ^^ Produced ID r�
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Form of Identification Cn �+ Form of Identification �,• Q
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Personally known(Lobbyist) c o Personally known (Principal) h ti Cca 44,
VII. SIGNATURE AND STAMP OF NOTARY: .y` �.F%
State of Florida,County of Miami-Dade W State of Florida,County of Miami-Dade a
Sworn to and subscribed before me p Sworn and subscribe efore me
T 13 day of Q ,201 ,��;. °'ao i _da of 201
Signature of P lic otary—,gate of Florida g1� Signat e of Public ory—State of Florida =°��•. o4c
Notarization of Lobbyist' gnature Notari ation of taPrincipal's signature
7, TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ 4 r MCR# 7 ` Date aid
Lobbyist Registration Form received and verified by:
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City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk@miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: �j as e-. F z,
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 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 Miami-Dade County mmission on Ethics and Public Trust.
777177
Signature: date:
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