Daniel G. Ciraldo - MDPL 72 La Gorce Drive MIAMIBEACH
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
NAME OF LOBBYIST: (Last) (First) (M.I)
3W 4- T-M. �L
BUSINESS.NAME AN DRESS- (Nur&er and.Street). (City). (State). (Zip Coda)
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact Information changes:address,phone,or e-mail address.
1, LOBBYIST RETAINED BY:
L
NAME OF PRINCIPAUCLIENT: O ' 7j_ 3�111 Vi O o
O
BUSINESS NAME AND ADDRESS (Number and Street) (Clay) (State) (Zip Code)
TELEPHONE NUMBER. ,)�^
(2). b FAX NUMBER:(Optional) EMAIL:(Optional) f1 b
A1ti
11� i .
Fill out.this-section_ff-principal.is a won,-Partnership-or Trust[Section-24W2(01
• 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.SipE+CCs F1C L09$Y ISS E:
P -A Ah4 D1�� A _ LA,-
Issue to be lobbied(Descift in detail):
111.WYAGENCIESANDMOUALS TO 13E L0131 IED:
Pursuant to Cky Code Section 2482(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
r commencement of service with the cityto the present date,stating the eneral nature of the subject contractual relationship.
Sec
Z482(a)(4)'Fult Name of-Indliddual and- ContractuatRelationship(Explain) YES NO
title of pemon to be lobbied
Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financl -fami11141=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. w01 r
Sec 2 Any Financial FBI or Professional Relation
I
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATIO (D CLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) _ �) �)Z'✓1 4L
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
Issues":
_Yes\"No: Are You lobbying on a present or pending bid for goods,equipment or services,or on a present or rending
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
gevelopment 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
item,shall register with the clerk as required by this section but, shall not be required to pay any registration fees.
VYes—No: Are you representing snot-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 SHAW-BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signatu a 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 2482 of the Miam' ach City a and reportingf re uirements.
Signature of Lobbyist:
Signature of Principal/Clien
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
_Produced ID Produced ID
Form of Identification Form of IdentifiCationr-.a
Personally known(Lobbyist) Personally known(Principal)
CZ
VII. SIGNATURE AND STAMP OF NOTARY: . )
�- -
State of Florida,County of Miami-Dade State of Florida,County of Miami-Dade
•,�:��:"•.,,y SOFIA TERAAZAS <<
Sworn to and subscribo-before me 't My COMMISSION fi FF 105996 Sworn nd subscrib efore me
This da ,201 �. EXPIRES:March 25,20113 This ay 20' '
yf1��`•� Bonded Thru Notary Public Underwriters I� —T i •. '
Signat lof rblic N ary- e of Florida Signature of PoPrLWal's li tary State of Florida'Notario f Lobbyist's signature Notarization signature
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:
F.\CLERA$ALLkaFORMS\L0BBYIST F0RMS\Lobb0 Annual:R."istration t=orhl.doc Revised 01/22/2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
City of Miami Beath, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachf.gov
CITY CLERK Office
Rafael E. Granada, City Clerk CityClerk @miamibeachfl.gov
Tel:305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME:
i understand that no later than 1=ebr 2-9 of®aclr3tear9 1-must file the-following-form-,
pursuant to Section 2-455 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 2-455 (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 2-455.1, 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
_C-ounty 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 of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appeal to the Miami-Dade County Commission on Ethics and Public Trust.
Signature: Date:
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FACLERULWFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc