Domingo De la Fuente/Penrods
MiilR"lli Bcr;;K'l1
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
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 defined in any
manner in this section, 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.
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TELEPHONE NUMBER:
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FAX NUMBER:
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EMAIL:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CLIENT:
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BUSINESS NAME AND ADDRESS (Number and Street) (City)
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(State)
(Zip Code)
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TELEPHONE NUMBER:
(<!:oS'J5,3g- J!:>O()
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:
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IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATIO~ PARTNERjHIP OR TRUST:
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ll. SPECIFIC LOBBY ISSUE:
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CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
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Issue to be lobbied (Descri
Ill.
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
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, IV, DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
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1)
Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach Citv Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Procurement Issues":
Yes @
Are you lobbvina on a oresent or oendina bid for aoods. eauioment or services. or on a oresent
or oendina award for aoods. eauioment or service?
2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach Citv Code Chaoter 2, Article VII Division 5
thereof Entitled "Camoaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Real Estate Develooment Issues":
Yes
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST 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 PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPEND UR OR COMPENSATION DURING THE
REPORTING PERIOD.
I do solemnly swear that all of the foregoing facts are true and correct and h I have read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting
requirements,
Signature of Lobbyist:
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
Produced ID
Prod uced ID
Form of Identification
Form of Identification
Personally known (Lobbyist)
Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Swon~_to..il{ld subscrib bef~r me j\ tl
(~::~bJ__da of 201L 7
Signature of Public Notary - State of Florida
Notarization of Lobbyist's signature
"'~>>''''''f'''''' Crisele Torres
f.~ ~ MY COMMISSION # DDl~4 EXPIRES
~. ; : January 9, 2007
~-1,t.:iift~ ~ BONOEDTHRU DOY FAIN INSURANCE. IHe
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This _day of . 20_
Signature of Public Notary - State of Florida
Notarization of Principal's signature
/" FOR CLE~ USE ONLY
Annual Registration fee: [./] Yes [ ] No Am u Peid(;l~'frD MCR #
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F: CLE L\MARIA-M\LOBBYIS1\LOBBYIST FORM 04
Date paid~ 'f
APR~Z7.D. D.:ZIPM FROM-TEW CARDENAS REBAK
tS055361118
(305) 538-1380
T-8B7 P,03/D7 F-515
p.5
Apr 28 04 09:3?a
Pearl
III. DI5CLOSURE Of TERMS AND AMOUNTS Of LOIIVUT COM'ENSAnDN (DISCLOSE WHmtER HOIJltL V,
FLA T itA TE OIl OTHEIl):
A) LOBBYIST DISCLOSURE; ("qui'H) ~-rsl t_ ,.
B) PRINCPAl.'S DISCLOSURE (OP lOBBYIST COMP!t6ATlON): (Ulllllred).-----&.1- '}os" I t;J~.,1.-
v_ eJ :: ........ntina a narofDr-araflt mmnratlan or ..ndtv without ~a1IlD",DlI!.-tIon ar
---c;iiiiii- _ . Pursuant to Ordinance No. ZOO4-3435.
1)
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~=;t :==;:';.,,:3::3~~~:e Miami RNrh C,ty tade rhaoter 2 Article VII Oivi&ian S
~ . . tJ" AddittM Of Cede: ~ 7-4RR EnlidM '"Pmhtlllted
e~~inn (bntrlhutinnc Rv I Mhvl..n On Pmtut'ernMt 1m;uM'"
2) =n~l'dinance Na H03-3395 Aml!ndina Miami Alolldl C\lY Cade ellaate!' 2 ~ VIr niW:ian S
C;~-;;;; ~~-r;;;~=ItJ" FInane" A"-- Via 1'j1e 411tt1ti<ln Of ode ~ '.400 EntlMd -PmhiblhKI
__ _ _!!' _ ___ll Bv Ulbbyift On Raal e_t2 nAvl!laament l~
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V. SIGNATVRi UNDIR OA,"'
ON OCTeJlliR 1 Sf Of 1lAOt VIM, EACH L088YISl" SHALL. SUeMlT TO THE cnv a.ERIC A SIGNED
STATD4ENT UNDeR OATH, U5T1NG L08I~G EXPINDITURlS. AS WIll AS COMPENSA'11ON
Jl!C!lVED. IN THE aTY or MIAMI BEACH fOR THE PR!CEDING CM.ENDAR YEAR. A SfA1'P4eNT
SHALL Bf fILm lWN IF THERE HAVE IEEN NO EXPEND OR COM' 1A1I0N DURING 11tE
REPORTING PERIOD.
Arevau "'blwl_"n.~i~'":~ otq.._tarMtVl~.lIrana-
01' MNllnfI aw_d fer...... 8aUIIIIIIMt Dr sel"Vlm'
1 do solemnly swear that an of the foregoing facts are true and correct Ind 1 haVe read or am
familiar with the provisions contained in Section 2-482 of ttle Miarni Beach City Code and an reporting
requirements.
Signature of Lobbyist: ""
SIgnature of Principal/Client; ~~
VI. LO'lYUTlDErnlFlCA~ PRlNQPM. IDINTIFlCAnoN.
Procluc:ecl1D
ProduceG lD
Form of ldentincation
Form df lclentifltllticm
~ known (principal)
Personally known (Lobbyist)
VU. SIGNATURE At\ID SY"AMP OF NOTARY:
state of Flotlda, Coun\y of Miami-Dade
Swam tD.JIld sull5c:ri be me ." J
C!:~ of 2~7
Signature of Public NoliJry - Ie or florida
Nlltarizatlon 0' Labbylst'li liigniIlvre
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.; . MYaMoISSIllN' 1IDl66644 IllPIIU
, . laNI.v'.2007
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Signature of Publ .Notiry
Nalariullc.n of rind cigNIwre
1/) Slwen J. S
...'" "'; My CommIAIon DD2l102A
... " Expim DIClImlIIr 20, 2007'
FOR CLlRK'1i use ONLY
Annual Rtgi$triliO/l fee: ( 1 'fa [ I No _lint PIIilI MeR . 0.. Plid
Labbyiat 1Ictisttalion Form r<<eived ItllI verhd by:
RIVilld 02/1010/1 f: C\.9\AU.\MARIA-M\lOBBVISTlLOBB'flST FOAM 04