Jessica Fernandez - Greater Miami - The Beaches Hotel Assn. Miami Beach 31�-LA-ric-6
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Office of the CityClerkIMI°""I 22 Am10: 13
1700 Convention Center Drive r-r' "y�a
Miami Beach, FL 33139 (. � L
305.673.7411
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 tens specifically includes the principal as well as any employee engaged in lobbying
activities.The term"Lobbyists has specific exclusions. Please refer to City Code Chapter 2,Article VII,Division 3,entitled"Lobbyists;
for additional information.
Instructions: Please complete all sections of this form and submit the completed form,with the applicable Me,to the Office of the City
Clerk. If you need more space to complete an answer, use a separate sheet(s) of paper. If you have nothing to report in a particular
section, you must write "none' or "rVa" in that section. Any change to any information originally filed, or any additional City
Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amendment to the registration form.
The lobbyist has a continuing duty to supply information and amend the forms filed throughout the period that the lobbying occurs.
Separate registration fors shall be required for each principal represented on each specific issue.
I. LOBBYIST INFORMATION: _
ernandcce
NAME OF LOBBYIST (Last) (First) (Midde Name)
A .
Pk Rdvisorci 13I MAve . Coal (,-abte,s FL_ 33/3N
LOBBYIST BUSINESS NAME APS ADDRESS (Number end Street) (City) (State) (Zip Code)
6 51 N'21lo5 305 3e5 fyeq •
Jessicate-JAi°AOiSOry . c
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER` EMAIL ADORES
SS�r
II. PRINCIPAL INFORMATION:
Kaitcot is \ J ndy
NAME OF PRINCIPAL (L (First) - (Middle Name)
hp?N MEd" Idic&/1 A-ve. *LI to
Ge-eatter MIami ` 4'1'x- beriLltee &socicdicei Mini Beard FL_ 3313 at
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) .
aje5 531 - '6553 335 ' 262. -Le 2_ wKallerISC mbkec, LOrn
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAW ADDRESS
•
• If the principal is a Corporation, Partnership or Trust, the following information MUST be provided
pursuant to City Code Section 2-482(c):
•
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write N/A): (A)SAA),
LJrkE /S
• NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION,PARTNERSHIP OR TRUST(if none,write N/A):
Page 1 of 5
III. ISSUE TO BE LOBBIED:
Describe with as much detail as is practical, including but not limited to a specific description where
applicable of a pending request for proposal, invitation to bid, or public hearing number.
k-iUmant�elci-rtear y CC ance IMpa.0 q he,+etg .
IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(aX4), list the City Commissioner or City personnel sought to be
lobbied, and whether the lobbyist has entered into any contractual relationship (paid or unpaid) with
said City Commissioner or City personnel from 12 months preceding such commencement of service
with the City to the present date, stating the general nature of the subject contractual relationship.
Full Name of Individual and Contractual Relationship(If yes,explain) YES NO
Title of Person to be Lobbied
Vdsttn
12•05en (sontat 2 /
M�LKy S(' l'e,n ber j
Mark 31AinuQC
14AV Ckael 6-&•nwfo
R ky R-rr, alti
C.CM EI� tine-kin ft1eIna n
fan Gelber
Pursuant to City Code Section 2482(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.
List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an
appearance of impropriety(if none,write N/A):
NJA
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note that a
contingency fee is prohibited pursuant to City Code Sec. 2-485.3):
5I5013 per rn n*
Page 2 of 5
...... ... .. ...
The following six(6)questions MUST be answered:
1) Pursuant to City Code Section 2-488,entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues':
_Yes No: Are you lobbying on a present or pendina bid for goods.equipment or services, or on a present or
pendina award for Goods,equipment or service?
2) Pursuant to City Code Section 2-490, entitled Prohibited Campaign Contributions By Lobbyists On Real Estate Development
Issues":/
_Yes No: Are you lobbvina on a pendina application for a Development Agreement with the City or application
for change of zoning map desianation or change to the City's Future Land Use Mao?
3) Pursuant to City Code Section 2-482(h), any person (except those exempt from the definition of lobbyist" as set forth in
Section 2-481)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 city clgrk as required by this section,but shall not be required to pay any registration fees.
_Yes Are you representing a not-for-profit corporation or entity without special compensation or
reimbursement?
4) Pursuant to City Code Section 2-481, the term lobbyist specifically excludes the following persons: Expert witnesses who
provide only scientific,technical or other specialized information or testimony in public meetings;any person who only appears
as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether direct,
indirect or contingent,to express support of or opposition to any tem;and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or
reimbursement for the appearance.
Yes No: Are you orovidina only scientific, technical or other specialized information: appearing as a
representative of a neighborhood association without special compensation or reimbursement or
representing a not-for-profit based organization for the purpose of requesting a grant without
special compensation or reimbursement?
5) Pursuant to City Code Section 2-491(1), no campaign consultant shall bbby the City Commission for a period of 12 months
following the swearing in of any elected official(s)for whom the campaign consutant provided campaign consulting services
within titey)ast election cycle.See Section 2-491 for more information.
_YesNo•: Have you provided campaign consulting services to an incumbent member of the City Commission
within the past election cycle?If yes,please list the incumbent member's)of the City Commission:
•
_Yes_No: If yes, has it been less than 12 months since the elected °Ucialts)whom you provided campaign
consulting services was sworn in?
6) Pursuant to City Code Section 2-4820)(4)a., a lobbyist who has within the past election cycle provided campaign consulting
services to an incumbent member of the City Commission (which lobbying activity is not otherwise prohibited by Code section
2-491) shall disclose such particular service on his/her lobbyist registration form an. shall . ,ll ds . u 'amcul,
service befjpe lobbvina the City Commission at a public meeting.
_
Yes -"go' Have•
you provided campaign consulting services to an incumbent member of the City Commission
within the oast election cycle?If yes,please list the incumbent member(s)of the City Commission:
_
Yes No: If yes, were you promised or did you receive economic consideration in exchange for campaign
consulting services?
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: el Yes I I No Amount Paid f MCR# 2' ? OS--1-
,l, 106/ Date Paid CX-
Lobbyist Registration Form received and verified by: A in14, S A"'s1 QTDAe.
F_\CLfR\,SALLI aFORMSrLO8nYIST FOPMS Lobbyist Registration Form Revised 01-01-18 REG.aoc
Revised 01/01/2018
Page 3 of 5
VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNED STATEMENT UNDER OATH. LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED. FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBY! T HA BE N -..p.' D T• Le :Y. A TATEMENT HA L BE FIE_a EVEN IF TH -E HA ;E NO
EXPENDIT RE OR Ctl L t e1 et9.lit G THE R ;.•RTIN PERIOD. C�
Signature of Lobbyist: E R.nn 7 M G..I 221 2 01 V
I do solemnly swear or affirm that all of the foregoing facts, statements, and disclosures in this form are true and correct,
and that I have read or :miller with t - provisions contained in Chapter 2, Art. VII, Division 3, entitled-Lobbyists" of
the Miami Beach City r ..- - d all ret• m requirement:. p
Signature of Lobbyist: ,�u�.'�- � d Date \A ck', 22, 7c I 5
Signature of Principal: 6f cavil • Date I \Lt,(f a-a, ac) 8
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST:''�� PRINCIPAL('
State of Ril c,:' 0.4 State of f-c.(�,6-1�h
County of: 4/AIA-ell - ip/kQF County of: /tA(AM(- F
Swony(o_(or affirmed)and subscribed before me Sworn to(or affirmed) and subscribed before me
this ..4,L day of AAA"( 20jrby this day of /4 ty 20[y', by
—3F}' SiCA- vRyucE 2 1A-1/4-•1/41D I" /4}LLG&c. iS
NAME OF LOBBYIST NAME OF PRINCIPAL
-
Produced ID fit L_ _Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
Personally Known Personally Known
2Si ure ofNot ary Public S \\atti``re of Notary Public
, ,.q meati N ✓>
i '„C.0 —Stott 571-4-4,-1-117"24"-:Name of Notary, Typeddd, Printed or Stamped Name of Notary,Typed, Printed or Stamped
,..4. JASON SALVATORE
(NOTARY S
MY COMMISSIONNGG oaosZT (NOTARY SFA ;A '"'*;'' JASON SALVA70RE
` EXPIRES:Septempar 14,N2) M.Y COMMISSIONO GG 030527
Barbee iNU NMmyPWic WtlNeMn ., „ ;' EXPIRES:September 14,2020
G 40.,1.ar'soeeee mu Notary Public UMefMgMe
' The term"lobbyist'specifically excludes the following persons:
Expert witnesses who provide only scientific,technical or other specialized information or testimony in public meetings;any person who
only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether
direct indirect or contingent,to express support of or opposition to any item; and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for
the appearance.
Page 4 of 5
City of Miami leach, 1700 Convention Center Drive,Miami Beach, Florida 33139,vrew.miamibeachfl.gov
Office of the City Clerk
Rafael E.Granada, City Clerk CityClerk@miamibeachfkgov
Tel: 305.673.741 1, Fax: 305473.7254
NAME OF LOBBYIST: "TE.sS I Cc,_ \--t t70.1\d E �.
1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT
Pursuant to City Code Section 2-485(d), the City Clerk shall notify any lobbyist (or
principal)who fails to file timely a Lobbyist Fee Expenditure and Compensation Statement
(Statement). In addition to any other penalties that may be imposed as provided in
Section 2-485.1, a fine of $50.00 a day shall be assessed for Statements 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 the Miami-Dade County Commission on Ethics and Public Trust.
I hereby acknowledge that on February 28 of each year, I shall submit to the City Clerk a
signed Statement under oath listing all lobbyist expenditures, as well as compensation
received, for the preceding calendar year with regard to the specific issue on which I have
been engaged to lobby.
2) LOBBYIST WITHDRAWAL
Once an issue I have registered to lobby has concluded or I am no longer lobbying on
that issue, I shall immediately file a Notice of Wthdrawal with the Office of the City Clerk.
3) ANNUAL LOBBYIST REGISTRATION FEE
I understand annual registration of all lobbyists shall be required for each
q 12-monthation period
commencing October 1 of each year, and the fee for such annual registration shall be
$500.00 pursuant to Section 2-482 of the Miami Beach City Code.
Iv 7 2) ZJl
/cure o Lobb 's Date
F 1CLER\SALLNFCRMSLCBBYIST FORMSLoM,nq Regtlraton Form Reviser/01-01-1S REG Nc
Page 5 of 5
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