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MIAMI BEACH ,_ '
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City of Miami Beach Office of the City 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
activi'
WIes. Th to m"Lobbyists,"has specific exclusions. Pllease refer to Ordinance 2004-3435.
kcI/r) s Tair 1 S
NAryf OF LOBBYIST: (Last) (First) (M.I) Ste' ci
Ki r V 1? - Iry too° O. P re f ctt t Pl CI al IC 33 w
BUSINESS NAME AND ADDRE (Number and Street) (City)
(State) (Zip Code)
4)
�� ,
TELEPHONE NUMBER: FAX NU B : EMAIL:
Please notify this office if your contact information changes:address,phone,or e-mail address.
I. OBBYI T RET INED B I _ 0
&lV2LI ✓. l �
sIpromptifeu� �� D60 ad i3on OIL )5 " ct 4 "� (Number d Street) ) j / (State) (Zip Code) /�/�aL id ti All
IV��A 1 �rV U Cl�. D �-/V I PHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2.482(c)]
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: Lat.)ri e &01‘.)\,0
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INgIR-E TLY,A Agr1140RE O NERSHIP IIN"TEREST INS H CORPORATION,
PARTNERSHIP OR TRUST: (c ,t�-�l 1 e. v,�7 give" ' r In%1‘) r,...% (c ,((i'ri-
II.SPECIFI LOBBY ISSUE:
1 nt i�tC r"i` `J�Ore �\.v�p l °�t ( G 1( (1NS f�`re.
Issue to be lobbied(Describe in tail):
Ill.CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
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
r title of person to be lobbied r''`; r
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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 perso''nel who is
sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2-482(g)Any Financial,Familial or Professional Relationship . , F--M-
•.
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F:ICLERI$ALL1aFORMSILOBBYIST FORMS\Lobbyist Registration Form.doc
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) 1.4901, afo
B) PRINCIPALS DISCLOS RE(OF LOBBYIST CPENSATION):
(REQUIRED). VI'Pr I CA 7-11'''`'
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
��Is��sues":
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 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 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.
Yes Ma' 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.
.....-....00"1111111.11........_
Sign. ure o Lobbyist
I do solemnly swear that all of the fo -•• g facts are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Mia I. ::a ' % ode and all reporting requirements.
i Signature of Lobbyist: ( e
•? i / ��/ ,�
Signature of Principal/Client: # CFf 244 -(��./�./
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
.1
Produced ID X Produced ID I lC 1k.1�,.J`•
Form of Identification Form of Identification
Personally known(Lobbyist) Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida,County of Miami-Dade V State of Florida,County of Miami-Dade
Sworn to a`, ubscrib-• •- or me V Swor -nd subscri•e• •-fore me
This 1'" biay of / V 1 V This . day of .A0 ,2015 •
Jr 12 I rie", SNANDA SUTTON LAVNE �—��`�� / ,!"'"!%� KRISTINA PUMA
MISSION li FF 092573
T•'na'''r:f o Publi +o'. ' ),.:.-orid XPIRES:April 4,2018 Signa ire of •ublic Notary—State cf•pr��. )• MY COMMISSION#FF118813
otarization of Lobb fist's !i ftt b. Bonded Thru Notary Public Underwriten3 ' • Notarization of Principal's signatur-"tat", EXPIRES April 27,2018
407)39e.01e3 Florldallota Servlce.com
TO BE COMPLETED BY Cdr CLERK'S STAFF ONLY ry
Annual Registration fee: [ Yes( ;No Amount Paid$ V,D MCR# qv 4f12-er Date Paid 5 a/4S
Lobbyist Registratton For received and verified by: lA.s�, AL.---- •
F:\CLER\$ALL\aFORMS\IQRBYISI'FORP'IS\Lobbyist Annual Registra ron Form.doc Revised 01/22/2014
F:\CLERI$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
CITY HALL CASHIER OFFI
1700 CONVENTION CNTR DR
05/12/2015 MIAMI BEACH, FL 33139
CREDIT CARD 1019:51
MC SALE
:ARD#
NVOICE X00000000(4259
EQ#:
0005#: 0005
)proval Code: 001149
try Method: 03350P
rde. Swiped City of Miami Beach-Florida
lEA Online Finance Department
MOUNT
$850,00 1 City Hall
1513220-1 05/12/2015 BR1 T131
Tue May12,2015 10:19AM Trans#5-5
CUSTOMER COPY 5 $850.00 MCRCLERK - MCR-City Clerk
* MCR#: 404125
1 ITEM(S): TOTAL: $850.00
Credit Car PAID $850.00
Have a nice day!
•
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Misccclaa aus Cash Receipt r 1 . #: �:-+: -J41 ' i5850-:00 T
CITY OF MIAMI BEACH
No. ;
0 Cash 'Credit Card 0 Check# • $ '.
I ._: 20 !i
Received of 11 '1 e 1/1 ? 1
Address le 00 2--cr - -_� � �.� a 3 .3-3 ? iy
For 0 44, 41/1 71,
(THIS INFORMATION MUST BE COMPLETED) Office of Finance Director
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By
Account Number: IL, =-`- `s&3 3 :. <. i -
Pre parer: / ti-; _ Dept:
CV\ I B k1/4 H
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: To gN A4tu-ww-S
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.l.._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$50.00 a day shall be assessed for all
Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal)
to file the Statement or pay the assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30th of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to e Miami-Dade County Commission on Ethics and Public Trust.
Sign ture: Date:
F:\CLER1$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc