Daniel G. Ciraldo - MDPL 600-610 Collins Ave.I
City of Miami.Beach.Office of the City Cleft
1700 Convention Center Drive, Miami Beach, FL 33139
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LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or n tahred,whemer paid or not,by a principal who seeps to encourage the fie,defeat or
modification of any ordinance, resolution, aeon or decision of any commissioner; any anion, decision, recommendation of the City
Manager or any city board-or committee;or any action,decision or recommendation of any city personnel during the thne period of the
oatire_detision4naking-process.-on-such-action,4edslon-or-mcommentlation-that fresseabiy*11-be.heard-or-rev swell-by Ow-sfiy
commission,or a city board,or committee•. The term fly includes the principal as well as any employee engaged In lobbying
activities. The tern"Lobbyists"has specific exclusions. Please refer to Ordinance
NAME OF LOBBYIST:
3-331
BUSINESS NAME - d. ,. Ptyl ): �.
TELEPHONE NUMBER: FAX NUNBER EMAIL:
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1. LOBBYIST WTAIiiIED BY:
NAME OF PRINCIPAUCLIENT:
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BUSIAIESS NAM AND ADDRESS and (City) ( �.' ..
TEt EPHO N �S_ FAX NUMBER:(Opdonal). HIAAIL(OPtigtal) !
Fitt:oul-thia-swA n:it ace
P fa on.P _or Tina![�tlon 2_M(c)j
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY.A 596 OR MORE OWNERSHIP INTEREST IN SUCH cowo ATION,
PI1I WERSHIP OR TRUST:
Issuetio be lot bied(Describe in doWa
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and► 'or :vft said sdty carnnbmiam or permed-bran.tY rno lhs
of servtoe wltlr the to fhe te teh prsedig pesors
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�c��SZ{a<��tj°Fuftirt o!' dli and Conbacfufi�etaiilorisldp(En) 'YES NO
we of person WAke'k6bled
Pursuit to c ry Code Seen 2-d`'�(9j Cveh► lst�nt'siasY be to atebe:the event of a ,uncial, d or final
roiatlo or otlar :rise to an appe�aece.of sn in in I ty,with any,cs nwd dty eonredesiorter or city pmsonrrel who Is
sought to be lobbied ea identified on the:lo�n6khalfon torn fdaiL
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHE:7 HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
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":
_Yek_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 2.490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Cov el opment Issues":
Yes : Are you lobbying on a pending application for a Development Agreement with the City or application for
change of zoning map desl-gnation 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.
4es—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 N THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE 14AVWBgEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signs of Lobbyist
I do solemnly swear that all of the foregoing facts are true andporrect and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami BeacbIlty Code/and ajkreporb g r uirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFIC N: PRINCIPAL IDENTIFICATION:
;Personally rod ced ID Form of Identification v
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A WHITE
�o�ary Public-State of Florida
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known(Lobbyist) Personally kn al) Commission*EE 220927
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VII. SIGNATURE AND STAMP OF NOTARY: a
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State of Florida,County of Miami-Dade rn State of Florida,County of Miami-Dade
Sworn to and subscribed bef re me / Sworn d subscri d re me
CD
This ay of 01 "! o This d ,201'
Signature of Public Notary–State of Florida o ® Signature of Public otary–State of Flo a
Notarization of Lobbyist's signature v, Notarization of Principal's sign r '
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TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration Registration fee: [. ];Yes[ ]'-No Amount Paid.$ MCR# =Date Paid.
Lobbyist Registration Form received an'd.verified by; -
F:\CLER.\$ALL\aFORMS\L06i3YIST FORMS\Lobbyist Annual:Registration Form.doc ReV95ed 01/2 /2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc %! ERIN E HENDRIX
• :': MY COMMISSION#EE 858128
EXPIRES February 03,2015
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City of 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
LOBBYIST NAME: &,.Jljd ( yr
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 301"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.
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Si ature: Date:
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