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Daniel G. Ciraldo - MDPL 310 Collins Ave.
' City of Miami.Beach.Off ma of the City Cle k 1700 Convention Center Drive, Miami Beach, FL 33139 0 � LOBBYIST REGEMAnoN FORM Lobbyist means all persons employed or retained,whether paid or not by a principal who seeks to encourage the fie,defeat or modification of any ordinance, resolution, action or decision of any cornmbskx ; any action, decision, recommendation of the City Manager or any city board or committee;or any action,decision or recm.nmendation of any city personnel during the time period of the _entire-decision-making.process-on-such aeon, decision-or-recorntnendatm that faeseeably wl8 be-mad-or-reviewed by the-may oommisslon,or a city board-or committee. The terra specilically includes the principal as well as any employee engaged In lobbying act The term°Lobb~has specific Please refer to Ordinance""443k NAME OF LOBBYIST: (Las;) (Flrst) (rt.� • . � 1�0l 33 eI�sINES�. . -and.street). (CRA ) (code) 41S3 , Gew;U , tam TELEPHONE NUMBER: FAX NUMBER- IBIAAtL• #'Iieas�notliry;. iPs.oi a if your dorrPct tit n�artfoi�r addi s, o ore-+,a idcliis+ss I. LOBBYIST RETAIWD W: NAME OF PRINCIPAUCLIENT: BUSINESS NAME AND ADDRESS p�lumbEr and saner (Oity� . (�� MP CW4 TELEPHONE FAX NUMBER(O EMAIL:(Op al) aw J OR F1111-atihia.sectlar.if is a Cwpomftnr Bar _or Thus!pkc*wZ4482(cil. •- NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY. - • -IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A S%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PAWNERSHW OR TRUST: RN Issu®m be toga(Describe In deter: U L r7..` -U- 0-901_ -.?. "_ 0.3 � gimpanilso Ir�tr, ►ooeYtr .. 'or'± 2 prang such person's -of swvke withfhe ta-thi 'ti natm ofthe- oo of :$ec 23X#y F'Wi he:bflh&AdUW'and- COftaftutRalk atanshiP(EStn); YCtiS NO title alt persm to.l bbbl� Pursciarrct to City Code See2ion 2-4= C ry.ngistrant'ahasl toe regc�ed fo Vie:the©ftfd of any ,tan Md or p r�ionslrip,� re rrg411"to an Opp of air hnpreprk",Vft any cuwwg dh►eonnn18aloner or city psnor1nd who Is sought to be lobbW W'.1dWiluftled,bn 1"IdbbyM rrsgMtradm form flb& ShG F p Vft25k Roboom C:) . FaCLER1 L:L�aFORMSIlOBB%MT FORMS1Lobby�si Reglstratim Form.doc _ oe l r + IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): f^ (REQUIRED). / 1.J 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) Pursuant 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 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 cleric 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: 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. 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 Miami B ch City Code an al4repo ng requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATI U PRINCIPAL IDENTIFICATION: ' ``� '` Produced ID V Produced ID .•`. rrr ••. NINA WHITE Form of Identification - "n{914ccbk-State of Florida +rte'• ,�, F My Comm.Expires Nov 21,2016 / "'•;'F Commission#EE 220927 Personally known(Lobbyist) -< �/ Personally k wn'' i ci al p� m VII. SIGNATURE AND STAMP OF NOTARY: ; Z n m State of Florida,County of Miami-Dade � O = State of Florida,County of Miami-Dade Sworn t subscribed b ore me _ 2 03 Z m Sworn,and subscri a re me This day of 6Ci ,201 # Z his day ,201 w m � NMX cSignature of Public Nota —State of Florida Signature of Public ry—State of Florida Notarization of Lobbyist's signature ,¢_ :�" Notarization of Principal's 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:_\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Forrn.doc Revised 01/22/2014 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc I A M.I B LAC : . City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfi.gov CITY CLERK Office Rafael E.Granado,City Clerk CityClerk@miamibeachfl.gov Tel:305.673.7411 ,Fax:305.673.7254 LOBBYIST NAME: 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 clay shall be assessed for all Statement(s) filed after the clue 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 appealed to the Miami-Dad County Commission on Ethics and Public Trust. Signature: Date: FACLERULWFORMSILOBBYIST FORMS\Lobbyist Registration Form.doc