Carlos Gutierrez - Consumer Healthcare Products Association ukiN3 Cv
M I AN11 EAC H Office of the City Clerk Zil! Fs 4
1700.Convention.Center Driver -
Miami Beach, FL 33139 •,--„f r l
305.673.7411 . oC.c ''
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 foreseeablywill 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 City Code Chapter 2, Article VII, Division 3,;entitled"Lobbyists,".
for additional information..
Instructions: .Please complete allsections of this form and submit the completed form,with the applicable fee; 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 "n/a" in that section Any change to any information originallyfiled, or.any additional City
Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amendmentto 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 forms shall be required for each principal represented on each specific issue.
I. LOBBYIST INFORMATION:
Gutierrez Carlos : I.
NAME OF LOBBYIST (Last) (First) (Middle Name)
1625 I "Eye".Street NW, Suite 600 . Washington . DC . . 20006
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code).
202-429-3521 cgutierrez@chpa.org
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS ..
II. PRINCIPAL INFORMATION:
Consumer Healthcare Products Association
NAME OF PRINCIPAL (Last): (First) (Middle Name)
1625 I "Eye"Street NW, Suite 600 Washington DC 20006
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) . (City) (State). (Zip Code)
202-429-9260 rmcluckie@chpa.org
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
Pur'su nt to City Code Sgation 21'482(1i)($)(a): Q prin'cipaI of 04,corporation, partnersfiip,CB other entity who .. . Ep i lobbyist CLl behalf of that
entity,without special compensation Cp reimbursement for flig appearance,whether direct,indirect,Clf contingent,ap(MDZIBsu+•ort c c r o,•osition to
an Item shall register with the Clerk as required by this subsection but shall not be required to pay any registration fees:
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): David Spangler
• 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); N/A
P o
age1 f5 .
%/i
Ill..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..
Proposedsunscreen ordinance
IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4), 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 natureof the subject contractual relationship.
Full Name of Individual and Contractual.Relationship (If yes, explain) YES NO
Title of Person to be Lobbied
Mayor Dan Gelber . : X
Commissioner John Elizabeth Aleman X
Commissioner Ricky Arriola : X
Commissioner Michael Gongora X
Commissioner Joy Malakoff X . .
Commissioner Mark Samuelian X
Commissioner Micky Steinberg I R I X
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 personnelwho 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):.
N/A
V. DISCLOSE.RATE AND AMOUNT OF.LOBBYIST COMPENSATION - Be Specific. (Note that a
contingencyfee is prohibited pursuant to City Code Sec. 2-485.3):
Salaried
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_x 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 City Code Section 2-490, entitled"Prohibited Campaign Contributions By.Lobbyists.On Real Estate Development.
Issues,.
Yes x No: Are you lobbying on a pending application for a Development Agreementwith the City or application
for change of zoning mapdesignation or change to.the City's Future Land Use Map?
3) Pursuant to City Code Section 2-482(h), any person (except those exempt from the definition of"lobbyist" as set forth in
Section 2-48.1)who only appears as a representative of a not-for-profit corporation orentity 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 clerk as required by this section,but shall not be required to pay any registration fees.
_Yes xNo: 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 personwho 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 personwho only appears as a representative of
not-for-profit community basedorganization for the purpose of requesting a grant without specialcompensation or
reimbursement for the appearance.'
Yes x No: Are you providing only scientific, technical or other specialized information; appearing as "a
representative ofa neighborhood association withoutspecial compensationor reimbursementor
representing a not-for-profit based organization for the purpose of requesting a grant without
special compensationor reimbursement?
5) .: Pursuant to City Code Section 2-491(1), no campaign consultant shall lobby the City Commission for a period of 12 months
following the swearing in of any elected official(s) for whom the campaign consultant provided campaign consulting services
within the past election cycle. See Section"2-491 for more information.
Yes x No 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 official(s) whom you provided campaign
consulting services was sworn inr
6) Pursuant to City Code Section 2-482(a)(4)a., a lobbyist who has within the past election cycle providedcampaign 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 and shall orally disclose such particular
service before lobbying the City Commission at a public meeting..:
Yes xNo: Have youprovided 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, were you promised or did you receive economic consideration in exchange for campaiq
—. consulting services,
TO BE COMPLETEDCITY CLERK'S S
BY STAFF ONLY
Annual Registration fee: ['N Yes[ ]No 'Amount Paid$" MCR# 13 t 3 Date Paid 05` -t \.
Lobbyist Registration Form received and verified by: 4.>-N=*-`i) S'
F:\CLER\$ALL\aFORPNS\LOBBYIST FORP9S\Lobbyist Registration Form Revised 09-20-18 REG.doc Revised 09/20/2018
Page 3of5 .
: 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
LOBBYIST HAS BEEN.E GAG TO L I ,:BY. A ST EMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO.
EXPENDITURE OR CO NS ON D - G H ORTING PERIOD.' gt .. : :a
Signature of Lobbyist: IP ; Date 1 `�
I do solemnly swear or affirm that all of the foregoing.f -ts, statements, and"disclosures in this form are true and correct,.
• and that F. haveread or. a famili with t Prov' ns.c nt ' ed in Chapter 2, Art. VII, Division 3, entitled "Lobbyists"of
' the Miami.Beach City Co a and. I reporti g: eq it Gi
Signature of Lobbyist. -/. Date 3.I Il.� . :
Signature of Principal:. C. ell/ Date ' '—""""
PHYLLIS M.TAYLOR
VII. NOTARY' SIGNATURE AND SEAL: �OTARYPUBmy commission zsionETRICTOFCOLUMBIA
Fxpiws.May3I,2023.
LOBBYIST: PRINCIPAL _ _..�.�. . v5 '1 Ni.,
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St to of Sia of: . . . : \. : I : ,,...,. :.
Coon of: N,, County
Sworn,t (or affirmed)and subscribed.before me SworrLtO(or affirmed)and .ubscribed before:me ,x .
this r day of 4'f^G f ,20Z,-bythis A'day of MarCh , 20_1T, by : y
�^)0 l, 14l'Prri°z- l r�l� , "S qui l�/' ,•,,,,
NAME OF.LOBBYIST. NAME OF PRINCIPAL ';',.,::''1,„5,
Produced ID Produced IDt
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
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' �"Q 1'hviVf' t Oyist"specifically.excludes the following persons: I.,�a" .. AV .�N.0
�C ���. 4 1 .•••....• •
!Y r O F G,1,�... '00„ �Pi sl .0.
Ekittlt+ tnesses who provide only scientific, technical or other specialized information or testimony:in public meetifittepmy.pd?son 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 anyperson who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grantwithout special compensationor reimbursement for
the appearance.
Page 4 of 5 .
: - . . . : :
: MIAMI BEACH : - . . . i . . .. : : .-- . -- .
City of Miami.Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
Office of the City Clerk
Rafael E.Granado,City Clerk - . - - CityClerk@miamibeachfl.gov -
Tel:305.673.7411, Fax:305:673.7254
NAME OF LOBBYIST Carlos I:Gutierrez
1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT
Pursuant to City Code .Section. 2-485(d), the. City Clerkshall 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.
Sectio.n 2-485.1, a fine of $50.0:0 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) tofile 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.
1 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 calendaryear 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 Withdrawal with the Office of the City Clerk:
3) ANNUAL LOBBYIST REGISTRATION FEE
understand annual registration of all lobbyists shall be required for each::12-month period
commencing October 1 of each year, and the fee for such annual registration shall b
$5 0.00 p) .want to Sec en.2482 of the Miami Beach City Code: :
' . . . . . \ \°\ . \' - . .
111 Signature of Lobbyist ,. Date . -
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc
Page 5 of.5 .
Miscellaneous Cash Receipt
CITY OF MIAMI BEACH
No. 423137
In Cash El Credit Card brChedk# ' $
20
Reived of :>.�. ..r ; w ,w,t ic RC'
Ad a *neous-MCR-20(9 �;` , �.,. K.1)t:s aC ;;"1'.%t..
"SC �7
F0403309-0064 Adrian ...03/12/01,9 01 43PM, t.,w €
MCR OPEN(MCR)
Payment Amount: 850.00
OflitiF4PoRMATioN MUST BE COMPLETED) Office of Finance Director
By
Account Number: ..)A 57 000 1100 , .
r` t,
Preparers r ; , a.,.:. Dept: C. - EXT: