Echemendia Santiago
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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 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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(City) i"--f~
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FAX NUMBER:
(Zip Code) :5'-:5 I :S i
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EMAIL:
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TELEPHONE NUMBER:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CLIENT: l
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6nrJL ot Ovv.. oNI (" rA '-PiOU lor c:U Lf)" 1: or /La ~ fVVf 0 f)~ 100 j? .S~ {OV\.~ g-.
BUSINESS NAME AND ADDRESS (Number and Street) (City) ~ (Sta'te) ~ (Zip Code) ;33(;) j
1(~oS) 3, j - ?oft? 0
TELEPHONE NUMBER: 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:
.
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II.
SPECIFIC LOBBY ISSUE:
I.
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loC~ ~ ~S3 s 7R~ QuvuL.L. ..sua (~, c..OsW
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III.
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,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
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":
DYes D No: Are YOU lobbyinG on a oresent or oendinG bid for Goods. eauioment or services. or on a
oresent or oendinG award for Goods. eGuioment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By lobbyists On Real
Estate Development Issues";
DYes D No: Are you lobbyinG on a oendinG aoolication for a Deyelooment AGreement with the City or
aoolication for chanGe of zoninG mao desiGnation or chanGe to the City's Future Land Use
Mao?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) 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 clerk as required by this
section but, shall not be required to pay any registration fees..
DYes D No: Are you reoresentinG a not-for-orofit corooration or entity without soecial comoensation
or reimbursement.
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.
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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
req uirements.
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Signature of Lobbyist:
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
D Produced ID
D Produced ID
Form of Identification
Form of Identification
c:t1ersOnally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
~J\. Eliabeth 8ematdo
\.Y- j MyStllWiUl~cfliunty of Miami-Dade
...'/ ~t~ _subscriblidbefore me
This d-J;t;:/ day of LncV1cPl ,200S
A~ry/~~
Notarization of Lobbyist's signature
D Personally known (Principal)
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
./ FORCLEU'S-USEONLY 2. Jon ,-,,) , I S
Annual Registration fee: [./] Yes [ ] No Amoun} Paid ~,(; r; MCR #... 7 78 Date Paid .3 ~, 0
Lobbyist Registration Form received and verified by: /IUA./
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc Revised 12/08/04
__. - __.1-
N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBIIYIST COMPENSAnON (DISCLOSE WHETHER HOIJIU.Y,
FlAT RATE OIl OTHIR).
A) LOBBYIST DISCLOSURE: (Required) ;!j Rt. $" ( ""'~..(lI L/\
B) PlUHClPAL'S DlSQO&J.' (OF IOllIIYIST COMPENSATION)' 1_. I "~ > 6 ~ ~{ t ~
The following Informetlon mUlt be Inswered:
1) Pursuant to MiamI Beach aty Code Section 2-488 Entitled "Prohibited Campaign ConbibuUons By lobbyists
On Procurement Issues":
n Y~ No: Are YOU =:bvI::.::;;; c::::a:= ==lDment or ~C8L or on a
\ Dl'M8nt or D8IIdlna !!!mrd ~.. eautDlIIMlI: or 1IMVIc.?
,
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By lobbyists On Real
Estate Development Issues":
DYe. 0 '0: AI'II YOU Iobbvlna on . aendlna aDDlleatlon for a Dev8Iooment Aa.........t with the atv or
aDDllcatlon for chana. of zonlna maD d_lanatlon or chanae to the Cltv's Future Land Use
Mu1
3) Pursuant to Miami Beach Oty COde 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth In SectIon 2-481 above) who only appears as a representative of a not-for-proflt
corporation or entity without specIal compensation or reimbursement for the appearance, whether cIlrect, or
Indirect, to express support of or opposltlon to any Item, shall register with the clerk as required by this
section but, shall not be required to pay any reglstrBtion fees..
o Y_ "DIIIa:. ~re YOU l'IID..-.ntIna a not-for-DrofIt col"DOratlan or entltv without IID8daI comDllllll8I1on
or ....mlllu...ment. .
V. SlGNATUREUNDIROATH:
ON OCTOBER lIT OF EAOI YEAR, EACH LOBBYIST SHALL SUBMIT TO 'tHE CITY CLERK A SIGNED
STATEMENT UNDER OA'tH, LIStiNG LOBBYING EXPENDI1UUS, AS WELL AS COMPENSAnON
RI!CDVED, IN THE CITY OF MIAMI BEAat FOR 'tHE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILI!D EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD.
SlgnlltureotLobbylst
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar w.,the provisions contained in Sect:lon 2-482 of the Miami Bead1 Oty Code and all reporting
requlrel'T\flnts.
Signature of Lobbyist:
Signature of Prlndpal/Cient:
VI. LOIIYJST lDENnFlCAnON:
~
o Producecl 10
Form d Identlficatlon
jfersonallY known (Prlndpal)
Form of IdentificaUon
~rsonallY known (Lobbyl8t)
YD. SIGNATURE AND STAMP OF NOTARY:
(;b =:J=:;"tilUnty of Miami-Dade
...7'-' e~1i"~~ _~subscrlbf:d before me
This ~day of LrkM.c:A. . 2OQ.S
-s4~~~~
Notarization of lobbyist's .Ignature
State of Florida, County of Mlaml-~i!Ja\ SilvIa M Trlpp
Sworn and subscrl befo me. . My Com .
Th1'3.-'" of "Yl!Ja~2~;_" ....... 0'""""
~. // . . "-"jJIIes JanlJaly 08,2007
~.,bU.{.A. ,
Slgn~ Public Notary - State of Flor
NobIrlZIItlan of Principal'. s1glUltllre
POR~~ONLY
Annual ReglstrBtlon fee: [ ] Yes [ ] No Amount Pald .', C MCR #
Lobbyist RegIstration Form rec:etved and verified by:
F:\O.eR\$ALL\MARIA-M\LDbbyIsl:\LOBBYIST IORM OS.doc
Date PaId
Re\IIsed 12/08/04