Santiago Echemendia/Penrods
Miami 9~
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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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NAME OF LOBBYIST:
(Last)
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(First)
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(M.!)
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TELEPHONE NUMBER:
(City)
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FAX NUMBER:
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I. LOBBYIST RETAINED BY:
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NAME OF PRINCIP'Al./CLIENT:
hLtrj,.., 0 <fLlr:j/lh/l
OW D'..PQA
BUSINESS NAME AND ADDRESS
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(Number and Street) (City) r
t={
d"313 9
(State)
(Zip Code)
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TELEPHONE NUMBER:
l.!3o,\'lS3i. J '2.00
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:
~ {JnllDc1.
IDENTIFY ALL PERSONS HOLDING, DIRECfLY OR INDIRECfLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, J\ARTNERSHIP OR TRUST:
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II. SPECIFIC LOBBY ISSUE:
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III. CITY AGENCIES/INDIVIDUALS TO 8E LOBBIED:
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C)
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A) Full Name of Individual/Title
8) Any Financial, Familial or Professional Relation~p
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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)
f{I 3"15
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
.B3L{ S J.h on/
nsation or
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 BY Lobbvists On Procurement Issues":
Yes &
Are YOU lobbvina on a oresent or oendina bid for aoods, eauioment or selVices. or on a oresent
or oendina award for aoods, eauioment or selVice?
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 EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD. 4->
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and that 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
Produced 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
Sworn to and sUbscri~~.o~ece A I I
~~~
Signature of Public Notary - State of Florida
Notarization of Lobbyist's signature
,"~~1. Crilele Torres
to,>>:... MYCOMM1SSIONI 00166644 EXPIRES
~. . . Janumy 9, 2007
'..;r.Jif.:1Ii IlONDIOlHRU1IIO\'FAlNINSUIlANCf. INC
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
Annual Registration fee: ~es [ ] No Am u Pilid
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F: CLE
ONLY
MCR#
Date Paid i /36/6 ~
\MARIA-M\LOBBYIST\LOBBYIST FORM 04
Apr 28 04 09:36a Pearl (305) 538-1380
. APR-tr-04 04:Z8PM FROM-TEW CARDENAS REBAK +30553&111& T-887 P05/0T
lV. DlSa.05URE Of nllHs AND AMOUttTS Of LORVIST COMPtNSAnDfl (DISCLOSI WHiTtIER HOIJRL Y,
FLA T RA Tl' OR OTHf/l):
A) LOBBYIST Dlsa.05URE: CRlquired) . J'-( S
III PRlNCIPAl'S Dl5tLOSURE (Of LOBBYIST tOMPfNSAl1ON): (."ulrea). .. ~"i S }h o' V
Yes ~ ~:: re_nllNla Nlt-for.nrant ..............tlalllII' MItilV wlthaut~1 mrnaeft!llltlon or
~I:' me. Pul$l8llt to ordinaftCI No. 2004-3435.
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F-S85
1)
~~~;::=::. =~3=.nAmendlna MllImi Bi!alh r.1v C"nM Chllnrer' Article VII Division S
. F' n R . Via "'8 Addition Of ~ ~n ,-eRR ~ntitIed -Pmhihilllll
""",nakln nH\tTlhutian~ flv I nbbv~ rw. ProoJ,.-mMr t_IM'"
y-@
ar. vau tftlllwAna on .. lI~nt or ...ndina bid fer IIIIDIk. tl!lll...i....nt ar....,~ ar" a IINMftt
or ......Ina ....... far......... ..uinment: Dr servic:II?
2)
=~~~= No ~no:J-U9S Arnl!fldina Miami 8ead1 City CllCIe ChaDl2r 2. MidI! VII DMsion.5
. irJn Fi MM R.form" Via lb. Addirlnn or Cod~ ~ 2-MO ~nftrkad lIIPmhibbd
~~: =;=aB:=::=~=.::-~~:_ntWRh the dtv Dr
;;;'i;;~:~; d.;~ ~ zani"; m_D ....ft8Mn or c:hanae lID tile atv's Future LAnd u.. ....,
y..W
v.
SlGNATURJ ulllOU OATH.
ON OCTOIIIR l S1' OF IACH YEA~ IACtt LOUVIST SHALL SUIfldT TO THI an CLERK " SIGNED
STATEMENT UNDeR OATH, UST1NG LOBBYING EXPENDITURES, AS WRl AS COMPENSATION
RlCaYED, IN TIt" crIY Of MIAMI 8PCtt fOR THE PRICIDING CALENPM YEAR. A S1ATDleNT
SHAll. .1: fiLED EVIN If THERE HAVE BE!N NO EXP~1lU OR COMPENSAlION DURJNG THE
ItEPORnNG PfRlQD. ~.>
Sign ItUrt ot LolIlIyilt
[ do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting
requirement!;. ~
Signature of LobbVist: ~ ~
Signature of Prindpe1/0ient: ~
.. ..........- ~ - - - ~--
Produced 10
Produced 10
Form of ldentlfiCallOn
Form of Identification
Perscnally known (1.aItbyiIt)
VII. SlGNATURt: AND STAMP Of NOTARY:
~~ knawn fPt1nClpal)
51l11e of Florida, Count'( of
sworn and :;ubsCribed
ThIS W claV
Ie or FIor1da
Notarization of .lJIgnIture
1) SlIYtNl J. SlII,-
. . My Commiellcl1 D02
\; ~ Expileo O_ber2D~~
POR eU!RK"S USE ONLY
AnmIII RelislrMiotl fee: L ] VIS [ l NO _~ PoOid MCR N Oat. 'aid
Lobllyist Rllistralion For'" I'Klllvd MCI verililld by:
RevIMll 02/10104 ,: CLERWL\IilAIUA.M\L088YIS1\LOBBYlST FOAM 04