Grace Calvani MBLatinChamber 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 pass~ge, 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.
NAME OF LOBBYIST: (Last) (First) (M.I)
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
C r4c_e. lown,'
NAME OF PRINCIPAl/CLIENT:
BUSINESS NAME AND ADDRESS
TELEPHONE NUMBER:
Cdvm[oer' ?oeod,- F/z .
(Number and Street) (Ci~) (State) ~ (3p C~e)
F~ NUMBER: (Optional) ENAIL: (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. /G SPECIFIC LOBBY ISSUE:
tYe ,t
I~ue to be Iobbi~ (~ribe in de~il):
III. CITY AGENCi~ES/INDZVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
TV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBY;IST COMPENSATION (DISCLOSE WHETHER HOI. JRI
FL4 T,RA TE OR OTHER):.
A) LOBBYIST DISCLOSURE: (Required) _
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 Tssues':
~ Yes ~"~o: Are you Iobbyinq on a present or pendinq bid for qoods, eouipment or services~ or on ,.
g~sent or pendinq award for qoods, eauioment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled roh~b~ted Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes ~o: Are you Iobbyinq on a pendincl aooli~ai, ion for a Development Aqreement with the City o,
aoDlication for chanqe of zoninq map de$iqnation or chanqe to the City's Future Land Us,:
.Map?
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..
~/es [] No: Are you reoresentinq a not-for-profit corporation or entity without special compensatio~
_or reimbursement..
V. STGNATURE UNDER OATH:
ON OCTOBER :~ST 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 DUI~NG THE
REPORTING PERIOD.
- Sigr~ture of Lobbyist
! do solemnly swear that all of the foregoing facts are true and correct and that ! 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: J
[] Produced ID
Form of Identification
~Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
PRtrNCIPAL IDENTIFICATION:
Produced ID f- .... ~. .................... ' .....
Form of IddtJtJ~ CYNTHIA M. LEE
P~rson I;li]l~ cc~ssa~#ooo~e6 el
known (Princin~
State of Florida, County of Miami-Dade
Sworn to ~nd subscribe~l before me ~. Sworn and subscribed before me
This ~ay of.,~//~, 20~ Thls//~'~'~day of~ .~,~_-'_~/Z, 20~~
_,
b'g~ of Public Nota~ - State of Florida ~Ju;~;F~;~ic Nota~ - State of ~orida
No~zation of LobbyisYs signat~e ~rization of Principal's signature
,
FOR CL S ONLY
Lobbyist Registration Form rece~v' '-and verified by: ~ ,- .... ~a~e ~a
~:~C~R~A~L~AR~-~LobbyimLOBBYZST fOR~ 0S ~ ~ ~