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Felix M. Lasarte - Bellsouth Telecommunications, LLC • 103015th 5°1-,M cc m pe ach i F L MIAMIBEACH AM City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM 2015 O i -9 9 9: 4 3 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, recornriienda'tion of the .City 1 L..C. 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. �a J'ar+e. ix. (vl • NAME OF LOBBYIST: (Last) (First) (M.I) LG l'4 1,0 44 h1 - 3 2-So NE 1 J-1---, 4 3341 pi aryl' CL. 2S 12 1 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) / (Zip Code) j2DS)5' fr2fl7 ( 1)(@ I a da o-e l a N cAm LEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone,or e-mail address. I. LOBBYIST RETAINED BY: feI Ifuv-N-, TelecoMmu77ccrho/1 r!. LAC a eleo►r ict Val.t4-ei I i ctio;1.1 COrniOcATINI, 14TtT FL. NAME OF PRINCIPAL/CLIENT: L900 NW 1 C304-' rhienUe,/ Raw 11 I l..l i QYni PL e 3312(o BU INESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip C e) Ws 2,6)0- gOig aO D2 att.. Cal TE PHON 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: pu V I I C y he td corn rangy • IDENTIFY ALL PERSONS HOLDING,DJECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: p V h I I c I\I held ci rY\f)a r,y • IL SPECIFIC LOBBY ISSUE:; i O o 15-r"' ,f-}-. L�igm� 6ecich tat -3313g F iro nl0 r 2,0- 2.03 - Doci-(I)qgo Issue to be lobbied(Describe in detail): III.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 NIA N ��. plan ri I' Zun ry A I? 1annir\. IUD a.Vd f\t 1 1 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 N I A F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc . a IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) H rI\l ILck-f if I S B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): -1-1—ovY t\ QQ : .f '-l1 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": _YesiNo: 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,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 F 7 EN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signa ur-.(f bbyist -- — - I do solemnly swear that all of the foregoing facts are _- :nd correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code --s :II r-sorting require ents. Signature of Lobbyist: LLA.,1/4—Ze w- Signature of Principal/Client: t kl""tT F> ;c ^ VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID— Form of Identification Form of Identification 4_Personally known(Lobbyist) k Personally known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida,Co:qty of Miami - State of Florida,Co •- of Miami-Dade Sworn s . d sue cribed •-for- :.,0r�o DAGMARA AMARO Sworn d sub - s befo a me 4 ....r ' ?°'�...a. i fY COMMISSION#EE848962 T �.�'�' + 1�� This_.���� Of � r',,,i'•2� DAGMARA AMARO EXPIRES:NOVO4,2016 „sty p„ �d _,�.% Bonded thpough 1st State Insurance - 2.• `� MY COMMISSION#EE848962 oc Sigr 1 of Public Notary—State of Flon•a m°_. Signat - ''F TE ry— - EXPIRES:NOV 04 s s is ota State of -r�"'`" ,2016 Notar ation of Lobbyist's signature Notariza on of Principal's signatu Bonded through 1st State Insurance TO BE COMPLETED BY CITY CLERK'S STAFF ONLY r �� Annual Registration fee: [ Yes[ ]No Amount Paid$ .�5C�MCR# L(O b'3 - Date Paid 5 Lobbyist Registration Form r ived and verified by: F:\CLER\$ALL\aFORMS\LOBBY T FORMS\Lobbyist Annual eg s ration orm.doc Revised 01/22/2014 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc 1 MIAM [ BEACH 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: I)x 1111. La ar-i-e , I�J'9 a 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 suspen• m lobbying until all fines are paid, unless the fine has been appealed to the -de County Commission on Ethics and Public Trust. /6/ ./ Signature: Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc Miscellaneous Cash .Receipt ;:3CO a: I c .; .I 1 2 9/ 1r,-; CO 1. 1 { CITY.OF MIAMI BEACH s , ._ ._ i,_, t,I r_f : 44:10s. ' i50,11 No. `A . u2 ; Lam+•~-1.� f- C1:. 0 Credit Card Check# 3 13` $ i ;;=; Cash , , . oc- ok. 20 ' Received of . A ?3 . tc,..,� , 4 33 1 7 7 Address 2)'2.- '�� �� ��� V c � � For • )0 0.. / -S A i t t i-+ 1 3 f 73)1 (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director By Account Number: C i }Ili 563/0- 5.4/ CiLiti : : : Pre parer: )ti 1 \ �.Ce ._ Dept: 1 . ((er En' r7. 2 if P ePol City of Miami Beach-Florida Finance Department 1 City Hall 1528220-1 10/09/2015 BR1 T131 Fri Oct09,2015 09:30AM Trans#5-5 5 $850.00 MCRCLERK - MCR-City Clerk * MCR#: 408032 1 ITEM(S): TOTAL: $850.00 Check (00003137) PAID $850.00 Have a nice day!