Alexander P. Heckler - Greater Miami Teamlink Partnersr
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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
activities. The term"Lobbyists"has specific exclusions. Please refer to Ordl nce 20044435.
‘kiPc l A-1.6)(01) 61( P .,
NAME OF LOBBYIST: (Last) (First) (M.i)
L 01.E ar4 1 , 1. i at A '___t t ;1' Id10 , ' ILO
BUSINESS NAME AND ADDRESS
(Number and Street) ity) (,ate) (Zip Code)
- — ' 5 305 c03` S :�, �' r Lea, - rS .ego.
TELEP`laTI E N MBER: F4 -NUMBER: EMAiL•
Please notify this office if your contact Information changes:address,phone,ore-mall address.
I. LOBBYIST RETAINED BY:
.igireirirrailra-wir-e-:fri
NAME OF PRINCIPAL I' ' N • , •
(-( ti c NculYt 11(11'- f ,,1 _
BUS NEg/CP
NAME AND ADOR_SS (Numbe(and Street) (City) (State) (zip Code
C R Code)
e /WM i4 e 4 ` 1∎1 Au �itii c tiS , ,,d 9 0 Ai
TELEPHONE NUMBER: FAX NUMBER:(Oplonal) EMAIL:(Optional)
- / = i _•_•04(41 r 114 N Allr". 0 .GO vi-)
FIII out this sec+on If princ pal Is a Corporation,Partnership or Trust[Section 2-482(c)]
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: 5e K fit W441 11 4 1110070
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY a DIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
u:SPECIFICLLOBBY-ISSU :
s P. ,
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Issue to Lie iobbl (Describe in detail):
III.CITY.AG:ENCIESIINDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a).(4)Include the commissioner or personnel sought to ho 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 tho eneral 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 b= I. bled
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QA g Inf\f/%6 k Un ‘ a'
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Pursuant to City Coda Sectla 2(g)Every ri- ant 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
,
1 1 i ,:1
F:ICLERI$ALLIaFORMSILOBBYIST FORMSSLobbylst Registration Form.doc .- , F _, __i CI
Per
k- IV. DISdLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) r
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATIOIN): . +, ��k �, . D
(REQUIRED). -c-
The following information must be answered:
1) Pursu nt to Miami Beach City Code Section 2.486 Entitled'Prohibited Campaign Contributions By Lobbyists On Procurement
iss s":
_Yes_No: Aire you lobbying on a present oIr pendinsr bid for oo
g ds.oguipment or services.or on a oresent or pending
award for goods.equipment or service?
2) Pursu to Miami Beach City Code Section 2.490 Entitled''Prohibited Campaign Contributions By Lobbyists On Real Estate
De cement Issues":
_Ye _No: ARyou lob ng on a pending application fora Development Agreement with the City or application for
ch- ..e of zonin! 1.,;, des!!natio or chain,e e CI ''s F to a Land Use, a.?
3) Pursuant to Miami Beach City Code Section 2-482(h)Any person(except those exempt torn(he 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
)em.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..Itiot-for-profit corporation otentlty without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR EACH OBBYIST HA__ SUBM 0 THE C a CLERK A SIGNED STATEMENT UNDER
.1 E PRECEDI L CALEND. ;YEAR: A STA EMENT S . .� ED _0 RE a EIVED i' THE C'TY OF MIAM BEACH FOR
OATH. LISTING LOBBYING EXPE DITURES A WELL AS. ] ENSA
L B; f H. .-E HAVE BEEN NO -•ENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD ,
Signature of Lobbyist
I do Solemnly swear that all oft, . oing is a;,- true d correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami B1.-- ; • C' =.and':11 rep'4 ing requirements.
1
Signature of Lobbyist: - ,�,^,4�n�:,•.-:t ..4
Signature of.PnncipaUClfertt: ; h r
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VI. LOBBYIST IDENTIFICATION:: A`"" 4- �, ��',.�,��°�"
,``+15„. NO,,, PRINCIPAL IDENTIFICATION: ;; , Z
Produced ID =°`- p- „> a m•.�� - :7/,-.1,- O� P duced ID c; 9 73 'c f
Fong of Identification =°� •.•• o - -. -0 m
4'ersonally •,p ,�,, Form of identification ° J.3'P' �..�H'...' ∎, rn u� Z known Lobb ist =(Lobbyist)1 , ° � Z Personally known s� �� � m
. g o ° y (Principal) T T Z
° 3 - ? ° cow• x '
VII. SIGNATURE AND STAMP OF NOTARY: a 2 -. c ;_
H W 6I1
M H — Z ( N CO O
State of Florida,County of Miami-Dade _ State of Florida,County of Miami-Dade ". . ( N
Sworn to subscri• • before me. H 4k cn m a.
�R 1 = T T a v Swam and scrib d before me
This . ! `day of ,201 Z co — o 33 This y of 201 `7
Signature of Public otiry— 'ate of Flo 6 p 40 Signature of Public Notary�-S-e 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 t No Amount Paid$ _ MCR�t 'O Date Paid l�l!i/e,
Lobbyist Registration Form recely r�and verified by: ERIC
r:trLER\.', I-LL arO Ms\i.o8EE'7'X$T F. Ryc' gL'JbbVist Annual Regist-ati n-t ri, cLJr_ Revised 01/22/2014.
F:ICLER1SAi.1.1aFORMSILQBBYIST FORMS1Lobbyisf Registration ForM.doc
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City of Miami Beach, 1 700 Convention Center Drive,Miami Beach,Florida 33139, •ww.miamibeachfl_gov
CITY CLERK Office
RaFael E.Granath:),City Cleric CityClerk @miamibeachFl,gov
Tel:305,673,741 1 ,Fox:305.673.7254
LOBBYIST NAME: priewavr a
I understand that no later than February 28 of Bach 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--455.1,a fine of$50.00 a day shall be assessed for all
Statement(s) filed after the due date. The City Clerk shall notify the. Miami-Dade
County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal)
to file the Statement or pay the assessed fines after notification.
Any to• • st, who fai to file a required Statement by April 30th of each year,shall be
auto atl y - -=pe '■.•ed fro 7 lobbying until all fines are paid, unless the fine has been
apps led • lent-Dade •aunty Commission on Ethics and Public Trust.
Signature _ate:
•
F:ICLERI$ALL1aFORMSSLOBBYIST FORMS1Lobbyist Registration Form.doc
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