Luis A. Gazitua - Miami Helicopter / Michael Roth \4-01,e01+ Siel-Q3
MOAMIEzCH 0
City of Miami Beach Office of the City Clerk f
1700 Convention Center Drive, Miami Beach, FL 33139, a' i 3 AM 10:
LOBBYIST REGISTRATION FORM
Lobbyist.means all persons employed or retained, whether paid or not, by a principal who seeks 1-o 'en courage'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.
Gazitua Luis A.
NAME OF LOBBYIST: (Last) (First) (M.I)
Gazitua Letelier 95 Merrick Way, 3rd floor Miami, FL 33134
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-424-1666 —— info @gazitua.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Miami Helicopter- Michael Roth
NAME OF PRINCIPAL/CLIENT:
Miami Helicopter 14970 NW 42nd Ave, Opa-locka, FL 33054
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-687-0527 —— ——
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: Michael Roth
• IDENTIFY ALL PERSONS HOL I G,JRE�IIY OF IND1F CTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: VLII. 1( I(D�
II.SPECIFIC LOBBY ISSUE: [�CV,e,:+A,, —f—J o C O_ ?
Ala oN( _S�t-
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 /
Gl4{ rnal1Q -`l
(om m lsSlor�e.( i2 01 C). '/
Co vv.),yyl l ss I aYt Q{ Gcl tc.o ✓
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
/°
er-;
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
IV. DIS LOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBB 1ST DISCLOSURE:(Required) $c-
1 tb® �Qn��t f \\e't a r n�c 1 Cc
f `t 1
B) PRIN PAL'S DISCLOSURE(OF LOBBYI.T COMPENSATION): ,�-t 1 y ��� �
(REQUIR D). 5-, O C)O .4 O O 4/ ce7N
The foil wing information must be ans ered:
1) Pursuant to Miami Beach City C de Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Issues":
Yes No: Are you lobbying on a pr sent 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 Glide 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
yem, 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 FE RUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH, (STING LOBBYING EXPENDIT�JRES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PR CEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Si .. ure of :..yist
dll
I do soleimnly swear that all of the foregoing facts are tr - -nd correct and that I have read or a - ar wth the provisions contained
in Secti n 2-482 of the Miami Beach City Code and all re•.- - quirements.
Signatur of Lobbyist: -Attr- -1111111.11111111*. 411.
Signatur of Principal/Client:4-r f
VI. LOBBYIST IDENTIFICATION PRINCIPAL IDENTIFICATION:
JProducedlD
)( Produced ID " '--
Form of Identifcation Form of Identification
Personally known(Lobbyist) Personally knnw�p i ERT R.DIAZ
Y r u i pa-y PUBLIC,STATE OF NEW YORK
NO.Q1 DI6227237
VII. SIGNATURE AND STAMP OF ' OTARY: Qualified in Nassau County
My Commission Expires Aug.30,2018
State of lorida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn t• and subscribed before me Sworn and subscribed b fore me
This i ' day of M , 201 " :; ..-; _ j� 0ihi ( day old , 2014
F �i7�,' :7:`
. .r MY - /-�
• COMMISSION
� /III' � ,._
4. EXPIRES .-':v
Signature of Public Notary-State of Flori.� -•.. - k-: Notary State of Fla n%2•�✓�of 1`
Notarization of Lobbyist's signature ' �� °�w fb' "`-°f°.L L"•:-.."' on of Princip s signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ SO 0917 MCR# 13-51 It 6 Date Paid i5-IT--H1
Lobbyist Registration Form received and v rifled by: `�
.. ,_�R.1cz •:TS".. _ :, _ L:.., . -_. ,, ._ ...,;::: Revised 01/22/2014
F:1CLE- $ALL1aFORMS\LOBBYIST FORMS1Lobbyist Registration Form.doc
B EACH
;1 1116 y' '1 III
'�II 5�r I�
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: Luis Andre Gazitua
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 30t of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
Si ire: Date:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
M AM I BEACH
City of Miami Beach
1700 Convention Center Drive 2H6 MAY 13 Ail 10: 21
Miami Beach, Florida 33139
www.miamibeachfl.gov CITY
City Clerk's Office
Tel: 305-673-7411
Fax: 305-673-7254 Office Use Only
ANNUAL LOBBYIST 'REGISTRATION FORM
Name: Luis A. Gazitua
Business Name: Gazitua Letelier
Address: 95 Merrick Way 3rd floor, Coral Gables, FL 33134
Office Telephone Number: 305-424-1666
Cellular Telephone Number:
Email Address: info @gazitua.com
If more than one lobbyist, please list:
1)
2)
3)
4)
5)
6)
7)
Submit this form to the Office of the City Clerk, along with a check for $500 for each
lobbyist. Please make the check(s) payable to the City of Miami Beach.
For City Clerk's Office Use Only
MCR#: Oct ?L
Amount paid: SI)° Ci'D Date paid: (C-13-k
Processed by: Date: 05-1r3-1
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