Sergio Abreu - Teco Peoples Gasf
..
,) ,-ray aeis .-ra i,se
AA 1 AAA 1 B
•
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139 :L ,. = . i k=
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) 0 a
1
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): A)0/1)C
(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 V_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":
_YesV_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 V 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 REC , N THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED E EN IF ERE H VE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Ili F
Signature of Lobby's.
I do solemnly swear that all of the for:•oing fact - - rue and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami :et aty Code and all r:porting requirements.
r
`Signature of Lobbyist: It t
Signature of Principal/Client:.9 p • ,,,,,,,,,,,, . .
VI. L BBYIST IDENTIFICATION: t' ,•d,5 • "o'. PRINCIPAL IDENTIFICATION:
Produced ID F�0( �—IriVers j",',I'•••m`? t Produced ID O ri .. (r : $, dp
Form of Identification Form of Identification ,GI, ;;
c z
Personally known(Lobbyist) o o r- Personally known(Principal)
B `c F o o 1, r
VII. SIGNATURE AND STAMP OF NOTARY: o. x ` z a. B 2 r
v
7 , N m G. Z
State of Florida, County of Miami-Dade T R, u irj c State of Florida,County of Miami-Dade N rn
Sworn to an. subscribed before me _ ; d o Sworn and subscribe b ore me H
This - day of 0 ,2015_ CT, ,n ' This.2-C-day of , 201 j d o
' c0 N E tP LP -n .0
'Sig ature of Public N.tary-State of Florida " Sir ature of Public tary-State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY I
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ '.w.• MCR# MO,317% Date Paid J
Lobbyist Registration Fo received and verified by: it - a.
F:\CLFR\$ALL\aFORMS\LO BY/ST FORMS\Lobbyist Annual Registration Forrn,doc Revised 01/22/2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
M 1 A f\11, B E AC H
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granath), City Clerk CityClerk @miamibeachfl.gov
Tel:305.673.7411 ,Fax:305.673.7254
LOBBYIST NAME: Se ( v /1430,-eo
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 suspended from lobbying until all fines are paid, unless the fine has been
appealed to e Mimi-Dad- ounty Commission on Ethics and Public Trust.
el 1
G( 2c /S
g
Si nature: Da e:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
.,. ' 5 7 r hot(>. 11 '2 42, 4 5 ,rl 13 ,
;
Miscellaneous Cash Receipt _ -
1
CITY OF MIAMI BEACH F,. -
No.
❑.Cash Credit Card C7 Check# $ .SO1
Cas _
_ .,A). , . S .� 20 1.C7
Received of -<S . , r, _.
Address 4,10 k A) t/,) al s'r A- S 6 6 F'` c•,t 0 1k1 ... '4•
is -
iTif''''''''''47":.-L 40,-..:1,.--., (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director, , . ,_. _, ,
f
} ANe 011 Q , - . -a Account . —. „, : ..) k_e. '.
_ . .': ' , -Pre- aror. Cite rile' . 'c' ''.4 '`( EXT.
t
. - - - _. "- ..- . ..-,
CITY HALL CASHIER OFFI
(. fi 1700 CONVENTION CNTR DR
MIAMI BEACH, FL 33139
11/25/2015 11:33:06
CREDIT CARD
VISA SALE
�- CARD # • XX)OKXXXXXXXX0305
'.40.00- Chip Card: Visa Credit
Chip Card AID: A0000000031010
City of Miami : 10rk1a ATC:nt TC: D5D1CD350FD6472E
INVOICE 0012
1 City Hall - SEQ#: 0011
1532913-1 11/25/2015 BR1 T137 Batch#: 001676
Wed Nov25,2015 11 :33AM Trans#40-40 Approval Code: 025345
40 $850.00 MCRCLERK - MCR-City Clerk Entry Method: Chip Read
* MCR#: 408329 Mode: Issuer
1 ITEM(S): TOTAL: $850.00 Tax Amount: $0.00
Credit Car PAID $850.00 Cust Code:
Have a nice day! SALE AMOUNT $850.00
CUSTOMER COPY