Alexander P. Heckler - David Mancini & Albert Dominguez SLk"
AAIAMI BEACH toe( c ika -
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City of Miami Beach Office of the City Clerlsn �
1700 Convention Center Drive, Miami Beach, FL 13� 9' 0 010: 34
LOBBYIST REGISTRATION FORM 1 1_..,�, Y'�� %{(=
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"Lobbbyiis,ts"has specific exclusions. Please refer toOrdiinance 2004-3435
�1CXJLI— X U.errri-br -
NAME OF LOBBYIST: (Last) it (M.I)
USN P - gO\ � ►vr 1,, 5k - 0i �iavmi �'l _
BUSS NAME AND ADDRESS (Number and Str et) (City) I (State) I (Zip Code)
SOS Cog- ).-aSg� X514 S
TE\ HON UMBER: F UMBE : EMAIL: @ ,fy c
� 1 1
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
4 i &A. S k(a&. �&If I ,. 110 I
NAME RIND L/ L ENT: '
BUSmt a �w D Smber and Street) (City) (State) ( 'p Code)
TELEP E NU ER: 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: 0 01-Al 1 K POUICI 1) ( 100
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR IN9 ECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: /V
Il.SPECIFIC LOBBY ISSUE; ,
514(( VILCIAA chM2r-RYCIL. P 10
Issue to be lobbied(Describe in detail):
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
title of person to be lobbied
•
Pursuant to City Code S cti n 2-482(g)Every registrant shall be required to state the extent of any business,financial,familial or professional
relationship,or other relat onship 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
F:\CLER\$ALL\aFORMS\LOBBYIST 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):
n
A) LOBBYIST DISCLOSURE:(Required)
,N) D AM V 1 at L ^ n P^iNsAV 1a frz'w 'lee
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSAT O � n�,,�q
(REQUIRED). �V Vri(1I 0 1 VL W'v`Q€►vS a I �J ic -'
Th following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
1 Yes Issues":
_ _No: Are you Iobbvinq 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
yeveloment Issues":
_Ye _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
com nsation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any
it ,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 SHAL SU: IT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES,AS WELL AS •MPE SAT N RECEIV D, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHAL BE Fl i D E EN IF THE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD. ,1
. —
'gnature of Lo ',,i ist
I do solemnly swear that all of the foreg { g are true.-nd coffee.ans.that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Bea , City .od- , - I repo'ing req 'remen
Signature of Lobbyist:
Signature of Principal/Client: -- `�
VI. LOBBYIST IDENTIFICATION:
il
,Ad's- PRINCIPAL IDENTIFICATION: '
se e_Produced ID °".....N ,,,` • Produced ID ° �co
Form of Identification o Form of Identification 'b
io a AO m � i°WCO
Personally known(Lobbyist) g 3 « 6.o Personally known (Principal) a r
rn — 2
VII. SIGNATURE AND STAMP OF NOTARY: 1 ' i ' °
BHT � ��-`
T T m 8 Zt {u
State of Florida,County of Miami-Dade Q ; a. -. State of Florida, County of Miami-Dade .,
Sworn to a-ns 1subscribe,i-befor me N a ; Sworn . • ubscribed betty me
This ` t \day of ,201 ° '' d This ! to of G , 201 Vaiirt
0 ——— — 0 et `qt•#
Ad .., .�E„A_ I 1'
Signature of Public Notary–State of Florid. i n ture of P Ali ir otary–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# `t 6 (9 fa Date Paid !114
Lobbyist Registration Form received nd verified by: Fl
F:\CL \$ALL\aFD S\L BYI T FORM \Lobbyist Annual Registration -or . oc Revised 01/22/2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
MIA 1BEACH
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: PI e./r- 0,_,CIVA--ef
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 Statement or pay the assessed fines after notification.
Any I•bbyis• who ils to `e the required Statement by April 30t of each year, shall be
auto aticall sus ded om lobbying until all fines are paid, unless the fine has been
appe=led to Ili e Mi i-Da•',, County Commission on Ethics and Public Trust.
le 1 Signature: ate:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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City of Miami Beach-Florida
Finance Department
1 City Hall
1516120-1 06/10/2015 BR1 T131
Wed Jun10,2015 10:45AM Trans#6-6
6 $700.00 MCRCLERK - MCR-City Clerk
* MCR#: 404190
1 ITEM(S): TOTAL: $700,00
Check (0241) PAID $350,00
Check (0242) PAID $350,00
Have a nice day!
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For— • 1--! at fici i n.1 ' . �-J(/. !-..' ( . f'-1 t Y'+ = .•
_: (THIS.INFORMATION MUST BE.COMPLETED) .: . Office of Finance Director
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