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Daniel G. Ciraldo - MDPL 400 Collins Ave. City of Miami.Beach.Offim Of the.City Clerk. 400 Cp l 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 comma; any action, decision, recommendation of the City Manager or any city board or c ommittes;or any action,decision or of any city personnel during'the time.period of the -entire-decision4naking.process-on-such.action,�dedsion vrl wimendation.or. that foreseeabty-will-be-heard-or-reviewed-by ft-city commission,or a city board-or committee: The term qty includes the principal as well as any employee engaged In lobbying activities. The brnn "Labbylsts"has spec Me exclusions. Please refer to ordinance M"43k NAME OF LOBBYIST, (Last) (First) (M-0 3 �� 14 �. �.. 3331 ( : WCOM J�' _ZWL"'� I IVA,% TELEPHONE NUMBER: FAX NUMBER: EMAIL ybur 1. LOBBYIST RETAMED BY: l•`D Q-L NAME OF PRINCIPAUCLIENT: "J"wor" BUSINESS NAME AND ADDRESS p�lurnber end streeZ)O (City). ( P3P Coded TELEPHONE NUM ( L'(pp . FiA; .this session:if J i .. pdndpal Is a Co�aatlar4 Pmr _or'Ifu�[ 2182(c)l • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY. • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSH P INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: 11. MW Issues be khWed(Describe In detaup a_ ...�_. vX s..-_�._.-r • 1b Q OD'1 A �lif�[I�:�B m1Af E8r 01' iOHg l be h4 afltl W11 111Q�Q��I�ll�d lift- ! , ..ltd;or- .std city co"nisomm or personnrel froni..11 reontlw prss ing such person's Wof service with the t+e thi - .the natu+e of Vw. " cdiWwWd Sec F4agA )-F1dt :-d"n MdUai-and contrae�usrRe�tlo�ld YES No bf.Perim�, P O' lobbied-. Pcna�mt to 4:Uy Coft Sudw Wig)` !►r atHnt ahea be requind t±o-:tabu the-extent of any bus[�S;4hetin"UnPol or pnote:Nan - c ip ar bUrer :�Se to an ap tau�oe of an knpnoprlaty,wteh any c urrent dhi eonunlsaloner or oily personnd who Is sought to be lobbied ae--fd�tllted ari the;iobbyM re form tiiad. Sec. F 4w,P siorclf: °-- F.ICLEM$ALL%aFOF*SALOBBYtST-FORMS1Lo gist-Registration Fonn.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) j/0 ' n � B) PRINCIPAL'S PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): Q� (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_L: 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 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 Gig'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. kYes—No: Are you re resentin 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 CLERIC 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 AVE 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 ' ach City Code and I reporti r uirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICA ON: PRINCIPAL IDENTIFICATION: Produced ID Produced ID LZ60ZZ 33#uolsslwwo3 Form of Identification y•.� Lwn c inAffi ti6woo An B to 9XIS-ollgnd ARIOg ersonally known(Lobbyist) " n m Personally k rinc7pat�81a ��'''• "`'�`� VII. SIGNATURE AND STAMP OF NOTARY: N ; Z T in State of Florida,County of Miami-Dade O = State of Florida,County of Miami-Dade Sworn to apd subscribed be r me o, Z Z orn�nd subscribed re me This ay of 01� ft ® day (/ 201 O � K Signature of Public Notary—State of Florida Signature of Public Notary—State of Florida CO Notarization of Lobbyist's signature --' Notarization of Principal's signatu TO BE COMPLETED BY CITY CLERK'S STAFF ONLY v Annual Registration flee: [ ]Yes[ _ ]No -Amount-Paid.$ MCR# Date Paid Lobbyist Registration Form'received and verified by F:\CLER\$ALL\a-FORMS\LOBBYIST FORMS\Lobbyist AnnuaLRegistration Form.doc Revised 0 /22/2014 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc f - • MIAMIBEACH City aF 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 i LOBBYIST NAME: 4' V_4d � 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 30t'of each year, shall be automatically suspended from lobbying until all fines are paid, unless the fine has been appealed to the Miami-Dade County Commission on Ethics and Public Trust. a-V I e � /1 I/ -- 07 V Sig Lure: Date: FACLERUL.BaFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc