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Samantha Salgado - Women's International Film & Arts Festival De,avo I)aectc-4 , I AM 1 BEACH we SO ck A-ve- City of Miami Beach Office of the City Clerk 6�° C 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 2004-3435. x\ d0 Sam c cA NAME OF-LOBBYIST: (Last) (First) (M.I) (VI rl OflOa n (fl d(u., niKOS - N. M is vu4 Rea ch 32)1 cot BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) Scal o 3Lf inn or bcA n med c LL.oV fnc (m n ez TELEPHONE NUMBER: FAX NUMBER: WAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: Y\ /Mn n e_ M GQ.,0{mac ('3Y1 vJCJ-rr,P r,LS Zn-e r',r)01-trio.Q f i l Iry t. ArtS Ces4.14 a NAME OF PRINCIPAL/CLIENT: (Tr► ,� n ge—CO ci Dewft FU 33504 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) cn Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] - " - �s • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: 1Ci1,CA r - V • IDENTIFY ALL PERSONS HOLDING,DIRECT Y OR INDI ECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: . -- n.SPECIFIC LOBBY ISSUE:tied 's N(rai, Mid Issue to be lobbied(Describe in detail): III.CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:Colo i t,01( S Mt e„,,e. Pursuant to City Code Section 2-482(a)(4)include the commissioner or personnel sought to be lobbied,and whether the lobbyist has 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 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO title of person to be lobbied M�G►�l 6�-c lr, U►S n Co-n tonalfcw OZ-Trn Yn 1S51.51^RrP3 r..c6 Pursuant to City Code Section 2-482(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 2-482(g)Any Financial,Familial or Professional Relationship Ibo • F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc ?C Detail by Entity Name Page 1 of 2 FLORIDA DEPARTMENT OF STATE T. D iV`151O\ 0F C ORPOR 1'10\s top Detail by Entity Name Florida Non Profit Corporation THE WOMEN'S INTERNATIONAL FILM AND ARTS FESTIVAL, INC. Filing Information Document Number N05000010966 FEI/EIN Number 203774163 Date Filed 10/07/2005 Effective Date 09/30/2005 State FL Status ACTIVE Last Event REINSTATEMENT Event Date Filed 12/18/2014 Principal Address 7320 GRIFFIN ROAD, SUITE 103A DAVIE, FL 33314 Changed: 02/17/2015 Mailing Address BOX 120666 FORT LAUDERDALE, FL 33312 Changed: 05/26/2011 Registered Agent Name &Address MCCORMACK-LYONS, YVONNE 1113 SW 15 AVENUE, SUITE A FORT LAUDERDALE, FL 33312 Name Changed: 12/18/2014 Address Changed: 05/26/2011 Officer/Director Detail Name &Address Title P MCCORMACK-LYONS, YVONNE PO Box 120666 FORT LAUDERDALE, FL 33312 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 4/16/2015 } Detail by Entity Name Page 2 of 2 • Title D TANG, WINNIE PO Box 120666 FORT LAUDERDALE, FL 33312 Title D AVERY, DEVIN PO Box 120666 FORT LAUDERDALE, FL 33312 Title D GREY, KAREN PO Box 120666 FORT LAUDERDALE, FL 33312 Annual Reports Report Year Filed Date 2012 10/05/2012 2013 09/27/2013 2014 12/18/2014 Document Images 12/18/2014 -- REINSTATEMENT View image in PDF format 09/27/2013 --ANNUAL REPORT , View image in PDF format 10/05/2012 -- REINSTATEMENT View image in PDF format 05/26/2011 -- REINSTATEMENT View image in PDF format 05/04/2009 --ANNUAL REPORT View image in PDF format 1 09/07/2008 -- ANNUAL REPORT View image in PDF format 09/05/2007 --ANNUAL REPORT View image in PDF format 07/11/2006 --ANNUAL REPORT View image in PDF format 10/07/2005 -- Domestic Non-Profit View image in PDF format 1 Copvrioht©and Privacy Policies State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 4/1 6/20 1 5 2014 FLORIDA NON PROFIT CORPORATION REINSTATEMENT FILED DOCUMENT#N05000010966 Dec 18, 2014 Secretary of State Entity Name: THE WOMEN'S INTERNATIONAL FILM AND ARTS FESTIVAL, INC. CR0031009383 Current Principal Place of Business: 1113 SW 15 AVENUE FORT LAUDERDALE, FL 33312 Current Mailing Address: BOX 120666 FORT LAUDERDALE, FL 33312 FEI Number: 20-3774163 Certificate of Status Desired: No Name and Address of Current Registered Agent: MCCORMACK-LYONS,YVONNE 1113 SW 15 AVENUE,SUITE A FORT LAUDERDALE,FL 33312 US The above named entity submits this statement for the purpose of changing its registered office or registered agent,or both,in the State of Florida. SIGNATURE: YVONNE MCCORMACK-LYONS 12/18/2014 Electronic Signature of Registered Agent Date Officer/Director Detail : Title P Title D Name MCCORMACK-LYONS,YVONNE Name TANG,WINNIE Address PO BOX 120666 Address PO BOX 120666 City-State-Zip: FORT LAUDERDALE FL 33312 City-State-Zip: FORT LAUDERDALE FL 33312 Title D Title D Name AVERY,DEVIN Name GREY,KAREN Address PO BOX 120666 Address PO BOX 120666 City-State-Zip: FORT LAUDERDALE FL 33312 City-State-Zip: FORT LAUDERDALE FL 33312 I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath;that lam an officer or director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 617,Florida Statutes;and that my name appears above,or on an attachment with all other like empowered. SIGNATURE:YVONNE MCCORMACK-LYONS PRESIDENT 12/18/2014 Electronic Signature of Signing Officer/Director Detail Date I IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) 1QO B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). n/O 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 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 \ Development Issues": _Yes YNo: 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 \ifitem,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: 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 (361419-C14) I do solemnly swear that all of the foregoing facts are true and correct and at I have read or am familiar with the provisions contained in Section 2-482 of the Mia �i Beach City Code and all rep'rting requireme'ts.rue Signature of Lobbyist: i_i' f �+_ ►�'' gr,Signature of Principal/Client: . , VI. LOBBYIST IDENTIFICATION: -• 'RINCIPAL IDENTIFICATION: - a-O Produced ID o Produced ID W19(95-9(0 .5- � �[3 N Form of Identification `' Q>u_r• Form of Identification dLL N Y ag Oil Personally known(Lobbyist) . $ Personally known(Principal) M L;i VII. SIGNATURE AND STAMP OF NOTARY: W 8 a a mow$ State of Florida, County of Miami-Dade S • State of Florida, County of Miami-Dade Sworn • a d subscribed before me ,...«.u.. Sworn a • ubscribed before e his , �i/ day of ! ■ - , 201_15 =-�`�`' , -_ Rim V,ay of ► 1 1_ I,20115– Z_■40. ..- illi.1, Signature of Public Notary–State of Florida Signaturela'w.lic Notary Fate of •rida Notarization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLETED : CITY CLERK'S STAFF ON U Annual Registration fee: [ ]Yes No°i Amount Paid$ 0 MCR# A/F Date Paid ((Jo//5 Lobbyist Registration Form receiv d and verified by Arr '"' F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registra ion Form.doc Revised 01/22/2014 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc • 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: SG/frig Y)-J-1'x' SJ �OLe� 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 30th 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. 01C-Miac (912Pca- 4726 ignature: Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc