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Claudia M. Santacoloma - Motorola Solutions Inc. J(PC 6 C Lk(et/K-esA % \CL• 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 Ordinance 2004-3435. ,54A/7-4-60 1-0/v/4 CiA-110 4- M NAME OF LOBBYIST: (Last) (First) (MA) 1,4p ! 3/- 3/38 C gOOO 1� dhf,� /v0/ P! n/�zl�fa� Fi 333Z2 OA" �'IOyd�OL� �50 LU�!?iS/S �i5/ c5 �- Q � BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) el S4 - I Z3- i/Q 79 347- - 76,I-333-6" Cla✓c av;J�QnhuolOmQ g-nioloca46-0/0/1/voi,a7Pn TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: / / �j /%o'r0/4 &d/v/ 15 1l)C e�a(C/IQ 9�'/1/37160/roryiGt ��viv�' /4`GC[�v� liana/ --c./ NAME OF PRINCIPAL/CLIENT: / / N/olaroa c501 nj ��Gi g000 1, `Ji,14115- �/vJ P ot/ v/'o. ,L 3332-Z, (25X BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) •• S-y - SZO - 2-1/ TELEPHONE 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: 65 ®may 1izoL.`'� C� �Cr %cal A e 5-rci rtJ 447 �r/ .Sn we5/77r$(ii5)and 7 a0,,e �rlCe • IDENTIFY ALL PERSONS HOLDING,DIRECTL OR INDIRECTLY,A 5%OR MO E OWN RSHIP I TERIT IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Via l✓� A/" (4 MA Mara c"e4�, 4 /-, ; / /a.G -/�,oar Oibi`� /we5,tmc VAlanaO& e'1t �; Tate.- Van ✓avd fOLJ T-1 . ILSPECIFIC LOBBY ISSUE: / te / �� •/ P C01.0171-ea 7� rot /4o&o`Q &in mvnica koc 5 7odvc/5 5C1 ic&1 7� G�G I . Issue to be lobbied(Describe in d tail : s ( ) ul.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 ,Y� pp hictaa -eI dda I'C?/�`Iah0l 5 AlOnZ Qf/ouc 'L1 �m/ ioflG{I- O( ce if o,}/o i o�i c 4/0 fi// member D ��i�- Co,»rn i 5✓1Oil Wan-e 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. N--) Sec 2-482(g)Any Financial, Familial/o_or Professional Relationship 1/0/— /0/9)iCah ~ v •t F:\CLER\$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc -� : ' r IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RITE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) _/9 l)7-1 eci 2 n-79/0)/e e 1 B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENS#TION): J (REQUIRED). c�0/ocIe� 8�`4 0 y 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 V4o: 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": _Yes ✓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 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 ITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF Tel RE4'AV EN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. i1/ /0/ Signature of Lobbyist I do solemnly swear that all of the foregoing fa is are tru-j:nd correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Bea v.j ity Co o j / :II r:forting requirements. Signature of Lobbyist: r, I/ '1ri/,//3 Signature of Principal/Client: 1,4r_____ , VI. LOBBYIST IDENTIFICATIO',: PRINCIPAL IDENTIFICATION: Produced ID ®Produced ID .• Form of Identification a Form of Identification Personally known(Lobbyist) d!�p ®Personally known(Principal) _i �,N a VII. SIGNATURE AND STAMP OF NOTARY: °'z 5U)wg ::::,w 'State of Florida, County of Miami-Dade P-o a i` State of Florida,County of Miami-Dade - r Sworn to nd subscrib-• b-forp Mme y.3 Sworn ..nd subscn .befgrre,�me w This /J day of _ ?.._' 1, 201) a "is •- of ' 0 , 201_ ign. e •I Public ,,t- lStateo , da 4.....!::,>: /i•' .t - of -u•:f •t-ry—State • Florida Not. zation of Lo J yis 's signat . No .rization of rincipal's sig = = f• *.,�� TO BE COMPLETED Y, ITY CLERK'S STAFF ONLY / Annual Registration fee: ]Yes[ ]No Amount Paid$ Z MCR# Lt'® 'X 0 LIN Date Paid !' Lobbyist Registration Form received and verified by: L-0 a.-o.._1.,.fL.-, F:\CLER\O L\.FORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 01/22/2014 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc MAMBEACH 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: Novo), /7 ca/or") 6? 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 ft as 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 the Mia i- de County Commission on Ethics and Public Trust. a/ er i � Signature. Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc CITY MALL CASHIER OFFI e:111:1 1700 CONVENTION CNTR DR MIAMI BEACH,FL 33139 10:51:31 1OJ14J2015 CREDIT CARD AMEX SALE ---........00.0. .4 4 1 11004 CARD# ,fti AMERICAN EXPRESS Chip Card: A000000025010801 Chip Card AID: 0005 ATC: 507174BDE87976CA City of Miami Beach-Florida TC: 0013 Finance Department INVOICE 0011 SEQ#: 001265 1 City Hall Batch#: 821365 1528720-1 10/14/2015 A RM Trans*.30-30 Approval Code: Chip Read Wed Oct14,2015 10.51 lerk p Entry Method: Issuer 30 $850.00 MCRCLERK - MCR-City Mode:MCR#: 408049 $85U1UU 1 ITEMS): 850,00 0 PAID $ SALE AMOUNT Credit Car PAID Have a nice day! CUSTOMER COPY Miscellaneous Cash Receipt . _ __ CITYOF MIAMI BEACH i ; .� 4 .:. o :. - 6 t T'-. _�� ,"�y,?�f.."�T�Eo,[c`.rs '�:r' � � � No. } c 7 y u "::?-7...-'-''' ❑ Cash in Credit Card 0 Check# 20 / ' Received of jjjj �q 1 C Address F `' For +'��4/e:�-�` 6-6V/i -�' :r -_,.. /DI--ctv,.._1_,,) i .,....-„, ____., t,s_, --.(,_ _ ( 1 • ; .., • (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director By._ (41 -.?/-5.?j),) S 61 Li I'll - il-,,,,. Account Number: .7 Pre parer: / - C.._ .-.. - Dept: l P .: ,r. .> - - , 7-r . , - F_ a - ._t...... _. a^y..... .l•.. ,1 --L: ti :. ,..-t. .r... c.. .. ..5.']:...,