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Monica V Quinones - Desmond Child & Rudy Perez 0 416utA- -lc MIAMI B City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 It/1 5 ,1t` . i i i ; t;: � ; LOBBYIST REGISTRATION FORM Li ' ! , 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"Lobbyi "has specific exclusions. Ple se refer to Ordinance 2004-3435. ki k ti t:-S ®6,3 kc Lc\- v E ON LOBBYIST: (Last) (First) (M.I) t c 13 U2LL Of t 1»\ Lc rA 4 S q() i\-4 C et: BUSINE S NAME AND AD R SS (Nu ,=er and Street) (City) (State) (Zip Code) CA SE S --. I • ° 4. ---110 C\I,; ►, 5313 TELEPHONE NUMBER: FAX NUMB EMAIL: gi-ita% L, Co NI Please notify this office if your contact information changes:address,phone, ore-mail address. I. BBYIST RETAIVED BY: TEMo \ C--L A L� It C20- ailL?— N 'A1 B NCIPA LIENT: M 1\1 Lvi C01 � S k Ll 0(lJ j[Vj S lMEl A RESSo 0 qnber and Street) (City) aeL (_Zip d1 f\,c o J LA tit - ft, TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) J 3 D3 q Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: j VA CLA 14 • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II.SPECIFIC LOBBY ISSUE: Ap\k{ 1C (-94-,& ) ot■)C---TV•A E- Issue to be lobbied(Describe in detail): rS 0 . SCLOAN ENii") -t- ill.CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: ILEGuttitivQrS 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 H gY CA / 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 N1 JUL 132015 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc anti r Rc r I #/k IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) %`i 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": _Yes XNo: Are ou lobb in• on a .resent or •endin. bid for •oods e•ui•ment or services or on a .resent or •endin. 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": _YeslNo: Are ou lobb in• on a •endin• a.•lication for a Develo•ment A•reement with the Cit or a••lication for chan•e of zonin• ma• desi•nation or chan•e to the Cit 's Future Land Use Ma.? 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_No: Are ou re•resentin. a not-for-.rofit con•oration or entit without s•ecial corn•ensation 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 •� OM:,t?NSATION RECEIVED. IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEME HALL 71Y LED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERI'iD. Signature of Lobbyist I do solemnly swear that a . e for-doing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Mia :eac it Code and all re••rting requirements. Signature of Lobbyist: ` . , Signature of Principal/Client: - VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID - Form of Identification Form of Identification ersonally known (Lobbyist) ersonally known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade State of Florida,County of Miami-Dade Sworn to and subscribeefore me Sworn a d subscribe. •efore me Thi • •ay of fit LVA , 201 `3 This 0 day of _ , 201_0 TIMM" fith■-1 / , Sid, . - of Public To a State of Florida : •nature of Public Notary-State of Florida N. - •-•••w;* - •tarization of Principal's signature -*: 0.' .* '►:;Fh,:•{?SS!ON#EE 13443 I • - .. I• BE COMPLETED BY CI LE- Ann !I i'dti�ndf e;r�jhtr:tir'' I�U 1 , •I ount Paid$. IO+kC-. MCR. ' ?�,,� ,-k — _. e • I - Lob ._ ..,,,,...--------... -- - d bY, . I . .r,,.,:. .: . r-134436 r:\Ca ER 53 V'f a B FORMS = ,� r,n ,a ^ r -m IlR1 t.,t •e .ed 01/22/20.14 �, -� L,�,�;3rt5:;L'J�;��,`3 T r� i:.,\E:.cl��a_t.�..,,t,_-i _ r Wfl�i-e__•.�� i�`�;.�:1�` �` �� I /. 4"rll +4f N. ,"'''c Undemtiters F:\CLER\'•. - •'►i •:• . •;k ••.yist Registration Form.doc ,eglipc- .,a./THROSEN ► ■ '`��,..uu.,',,. Dv/ *i� s,c'Cl; E 134435 i 1 4 p� , MY COMMISSION HOSEN 134435 Wi p EY I S:t ,,ember 18,2015•��. :$. EKPIP.-. ',,e::[.,n:,er 18,2015 � � ,,��`.: ♦r<'N.. ,. ,....%,,,,61 :$.1 Bondee'. .,:a,;,'d�1�ic UndetWriters i e, g:•� Bonded Ina;f',n''r',,,,. „Rf„�. Public Underwifters MIAMIBEACH 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: 305.673.741 1 ,Fax:305.673.7254 LOBBYIST NAME: \\)10101 C C& lJ\Zb 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 lobbyi ¶• fails to file the required Statement by April 30th of each year,shall be •m . Ily spended from lobbying until all fines are paid, unless the fine has been appe:id to + e Miami-Dade County Commission on Ethics a • Public Trust Signature: Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc