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Daniel G. Ciraldo - MDPL North Beach Historic Districts M v ✓V M, tA/M- -'.JqBEACH� o� ti City..of.Miami.Beach.Ofrice of.the City Clerk_ 1700 Convention Center Drive, Miami Beach, FL 33139 I 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. Ptlleease refer to Ordinance 2004-3435 �� A d� 110 zz NAME OF LOBBYIST: (Last) (First) (M.I) BUSINESS_N, EAN DRESS.. (Nu r.and Street). (City)- (state)- (Zip Code) Ci tA�f6 IS 4a'J L) TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please:notory#his ofl�ii:e ifyour contact lnfortnation'changes:address,phone,or a-mall addraess. 1. LOBBYIST RETAINED BY: - MDR NAME OF PRINCIPALICLIENT: BUSINESS NAME AND ADDRESS (Number and Street)D (Clay) jState) ¢ip Code) TELEPHONE NUMBER-2 _ FAX NUMBER:(Optional) EMAIL:(Optional) �1 a 11� rVtV cir� Fill_opt..thiis..s ion.tf,pclndpal-Is a.Cation,-Part rship..or.T rust-jSectlm-2,452(c)] • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: !V G I✓ • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORAT N, PARTNERSHIP OR TRUST: r$ l¢7C "'A Issue to be lobbied(Describe in detail): Pursuant to City Code Section 2482(a)(4)include the commissioner or personnel sought to be lobbied,and whether the lobbyist 1has 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 24IMa)(4)Fu11-Name oftntlMduaCand Contractual-Relationship(Explain) YES NO � tide of person to be lobbied , r Pursuant to City Code Section 2452(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 Any Flnanctall Familial or Protessional Relatlonship /.3 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc ��Z .�� IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) C�_ 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 o: 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) fursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate evelopment 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 2482(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: I 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. Sign a of Lobbyist I do solemnly swear that all of he 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 - ach City Co a and all-reporting requi m nts. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID WZA&&- Form of Identification Form of Identification Personally known(Lobbyist) _Personally known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida,County of Miami-Dade State of Florida,County of Miami-Dade SOFIA TERRAZAS Sworn t and subscrib fore me :+E� Swor d subscrib before me ,�; A MY COMMISSION#FF 105996 3 This qd ,201 ��; 0.: E XPIRES:March 25,201a This day of ,201 'a:• Bonded Thru Notary Public Undervrr:lers Signat Pta'Signature Florida Signature of b c otary State of Florida Notarizati yist's Notarization of mcipal's signature TO BE COMPLETE BY CITY CLERK'S STAFF O Y Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# - Dat Paid Lobbyist Registration Form received and verified by: F:\CLtRX$ALL�aFOkMS`LOBBYIST FORMS\hobbyist Aha nuai.Regisirati h-Form:.doe Revised 01/22/2014 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc r A Vi \ ,I ti-i City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachf.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov Tel:305.673.7411 ,Fax: 305.673.7254 LOBBYIST NAME: t understand-that no-tater-thanlr February 2S of-each-Xear-, 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 2-455 (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$50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade .-County-Commission-on Ethics-and-Public Trust-of the failure--of-a-lobbyist-(-or-principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, who fails to file the required Statement by April 301' of each year, shall be automatically suspended from lobbying until all fines are paid, unless the fine has been appeal to the Miami-Dade County Commission on Ethics and Public Trust. Sign re: Date: FACLERI$ALL1aF0RMSIL0BBYIST FORMS\Lobbyist Registration Form.doc