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Lori A. Lynch - MBGLCC Foundation, Inc. G �+ - � e!1 A e A e w v® A 12 g !VIA/V\I °i k • . 1 City of Miami Beach Office of the;City Clerk 1 700 Convention Center Drive, Miami Beach, FL 3313N16 16 AUG 2 9 P1=1 I: 3 3 • LOBBYIST REGISTRATION FORM -. T Y OFF Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, deteat 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. L yeA NAME OF LOBBYIST: (Last) (First) (M.I) A / CC ��r9dctf M,/ .rxo. ii3o ��s�ii a� 4't /i9,dm/ A i A�Ft 33'39 BUSINESS NAME AND ADDRESS (Nurhber and Street) (City) • (State) (Zip Code) '34 - 3?7- 89/Y e311.5- ,73 - 8x83 LoR,defa9 ,vie-1'vi.. co/ TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes _address;phone,ore-mail address, I. LOBBYIST RETAINED B�Y: �' /79.M'L CC / 3///I e Lil», M e NAME OF PRINCIPAL/CLIENT: l-5 c7/79/ o7.5 (-)746 U BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) TELEPHONE E iti Jivio, rt: FAX i'1uiviocr:(Opuionai) EivwkiL:(upiiuilai) Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] / • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: �Z&UE ri �1e1,2 $ • IDENTIFY ALL PERSONS HOLDING DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: �� u;SPECIFIC'LOBBY ISSUE: _ Issue to be lobbied(Describe in detail): Ill.,Cl AGENCIES/1NbIVIDUALS TO_:ABE LOBBIES,: Pursuant to City Code Section 2-482(a)(4)include the commissioner or personnel souaht 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 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 be lobbied • �i/m /3 i fdC% tJCB3 c 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. C■• 9-4V(C) Ana .i ma, l i:on1ilisl• r Drnfeccinn.l Del.+i•nchin /1)0 D F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc r ` . + IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) n fC , 194/)./--- B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST C PE�ATION): (REO'ARID). p/ f / P/4f/ 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_ : Are ou Iobb-'n• on a •resent or endin_ bid for •oods e•ui•ment or s ervices,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 ne nln ant Ice,'cc"• Yes '4 o: Are ou Iobb in• on a •endin• a••lication for a Develo•ment A•reement with the Ci or a•.lication 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 Ccotion 9_A01 oho,ve) ,,,ho onl„ o nneorc oe � rerec enteti,,c of o not_for_nrolt r rotinn nr entity ,.ritho„t specie! 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 ••ir• /-AI et.nar.VCAn A c!TATC..C.1T`1-:AL..! fC C•1 en ICI:C.• •r• LiA\IC flee., .In CVne.•n,rl Inc.' nf1 I IIL i i.1 ...,ii."a -v T,LrIGiJTI% irJii�. R*, ir,Gir,L, i. -- i ii.-rV I_i L•3 ii II,i..Ii101W= v._*Il ,.v rii i_,IiJj I*IS. Vli COMPENSATION DURING THE REPORTING PERIOD. Signat t L yist -, .2"/ I do solemnly swear that all of the foregoi•• .cts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach • y Co•e and - po - g requirements. Signature of Lobbyist: / . Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: / ::)Produced ID l� C 2 kJeK S L i`C a� ^ .roduced ID ' J t_' `� • _ Form of Identification �.,`-' ti'yy" Form of Identification o o y O 1� �• 't ti Li M N Q Personally known(Lobbyist) 5e•,,-4"Qc.\,c —Personally known (Principal) ,,W . Ca up VII. SIGNATURE AND STAMP OF NOTARY: \QOQ'y°�Q � `` o.Q ro State of Florida, County of Miami-Dade =�coF�F�D' State of Florida,County of Miami-Dad 52 a-E F Sworn to -nd ubscnbe�refore e Sworn d subscriber before e , 0 T_,_ u n „I,II,i,, ' ' ca f c, D i-ii3 j ) -f ., ,L"J i� `,•Jg�iC 00 T f�. Jcu"�/i • 1(5'1,-201 /I = U D ilk 411_, . NA Signature o Public o ary–State of Florin. -„ .lg.PSE°,` _ Signatur- • Public Nota –State of Florid.' f-',_,,►sa Notarizati• of Lob•yist's signature ' """"" Notarizati•n of Principal's signature ,_ ;or+ ;loo: 5lP,, TO BE COMP ETED BY CITY CLERK'S STAFF ONLY Annual Registration tee: ( j Yes( )No Amount Paid$ MCR# Date Paid -2Y- - Lobbyist Registration Form receive and verified by: ..1 ✓4f F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc cap Revised 01/22/2014 F•v si FP1$A1 1 1oFf1RtAC11 nppyisT rnmoC11 nhh,ict Panictrotinn Fnrm rtnr A A i A A A t P A i? 1 /V\ I IV\ I DE/AL n L•�_ _f ..•--- a __._ /•. n _ rI.,.... . o-, , , ,,,,,,,,,.,,,,l.;r yu: CITY CLERK Office Rafael E. Granado, City Clerk CityClerk©miamibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: — 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. 111 I AQQVICT 1=111:MAIIIIT1111,1= Akin r'!Al*OCAIQATIAAJ CADS* 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 AU..-I ":a.. . £L_ •as_�s e+_r_ iii-ai c7iavi aiia .aiaiF3 iiwai3. i iiv vial "vivi Siiaii iniaiiy Liles 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 Tile the required Statement by April 3O of each year, shall be automatically suspended from lobbying until all fines are paid, unless the fne•has been appealed to the Miami-Dade County Commission on Ethics and Public Trust Signature: Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc