Daniel G. Ciraldo - MDPL 419 Michigan NAIAMI BEA .
City of Miami Beach..Office.of the Ci 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 20
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NAME OF LOBBYIST: (Last) (First) (M.I)
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BUSINESS NAME AN DRESS: (Nurrf6er and Street) (City) (State) (Zip Code)
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TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone,or e-mail address... --
1. LOBBYIST RETAINED BY: PIR
NAME OF PRlNCIPAUCLIENT: +Q ;1 PD V k -F�,�`O Zvi
BUSINESS NAME AND ADDRESS (Number and Street) (City) t(State) (Zip Code)- `
TELEPHONE NUMBER. ,,J_ _ b FAX NUMBER:(Optional) EMAIL:(Optional) it fA-
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Fill out this_section-If-principal.ls.a.Corporation,Partnership or Trust[Section 2-482(c)}
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: jV,0 Al-- PAIZ(
• IDENTIFY ALL PERSONS HOLDING DIRECTLY /
RECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
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PARTNERSHlP OR TRU&T:
II.SPECIFIC LOB-BY I+SS.UE:
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Issue to be lobbied(Describe iA detail):
III.MY AGEN IESA lDMIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2482(x)(4)include the commissioner or personnel sought to be lobbied,and whether the lobbyist bee entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 42 marths in
preced g such person's
commencement of service with the city to the present date,stating the eneral nature of the subject contractual relationship.
Sec 24182(a)(4)Full Name of Individual'and Contractual Relationship(Explain) YES NO
tide of person to be lobbied
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Pursuant to City Code Section 2-482(8)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.
Sac 2 Any FftumcK Faarilial or Professional ReiatlaWflip
FACLERULLWORMSILOBBYIST FORMS\Lobbyist Registration Form.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCL S WHETHERDHOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) rA
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST C MPENSATION):
(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":
_Ye 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 2490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
evelopment Issues":
_Ye 4 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
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 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-REC-EIVED, IN T-HE-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.
Signature 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 2-482 of the Mia Beach Ci Code and-all-r rting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID x Produced ID WQI�
Form of Identification Form of Identification
SPersonally known(Lobbyist) _Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida,County of Miami-Dade Ev,t* �� ta te of Florida,County of Miami-Dade
Swom to and subscribed efore me worn and subscribed afore me
MY COMMISSION#FF 105996
This day of 201 EXPIRES:March 25,2016 his a f _ 201
Sorbed Thru Notary Public Underwurkers
Signature lic No ry--St of Florida Signature o Principal's Notary State of Florida
Notarizati Lobb fist's sig Lure Notarization of signature
TO BE COMPLET52 BY CITY CLERK'S ST#FF ONLY •
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR.# =frgaAl Date Paid
Lobbyist Registration Foam received and verified by:
:'�1:.ER�1 I4L�.'�aP0 OLCD8E3YY I•��RN9��L®b i st r►rwa� �. �r� ion Form.doc a Revi5ed.0i/22/2014
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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: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME:
I- understand that no later than February 28 of each year, I-must file the fallowing-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 for-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
app led to the Miami-Dade County Commission on Ethics and Public Trust.
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Signature: Date:
FACLERULL1aFORMS10136YIST FORMS1Lobbyist Registration Form.doc