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Bob de la Fuente/New Florida Properties Corp. lD ...... MIAMIBEACH City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRA nON 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. k fa. rue-lit re- Ov~ ~ OF LOBBYIST: (Last) (First). (M.!) , Jew ~4!> I u--P /441 %deJl .If';!1-RoPY, i1tA:1-'h 3?1 ~I BUSINESS NAME AND ADDRESS (Number and Street) (City) , (State) f (Zip Code) ~,r, r3~ ' ~O ~_r.-.r~6 - III P 'b.h Pa. rewL,+tJ UYl1 TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: -1)Jeu) H()~/O.1 NAME OF PRINCIPAL/CLIENT: j?;:( o,f/ef-/l ('{ €:S C O/Zp . ~1'7 7 9' C~L~{I(.)S ~EeJUe BUSINESS NAME AND ADDRESS (Number and Street) ff Sf) ), (City) (" 60Y fr; ) d-ooIY FAX NUMBER: (Optional) In/~ AE'&C"~ (State) H 3:?,YJ (Zip Code) &s) 6'7.:3- ~6 r-y TELEPHONE NUMBER: 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: /fUC'C D A- TH-.gY'~:_ IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Hucto ~ 7dJO Y Oc:' II. SPECIFIC LOBBY ISSUE: it~ t31+/11{ilJ1i ~ ft/~ fJ1A,tf-~ J #J7 i((lut .fwt, ]7l>d c(.cJ.. Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship !0~ 1J~ fJ~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLA T RA TE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required), -$ ] 35/ H1;1vr ~13~) I~ 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": 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": DYes ~ Are YOU lobbvina on a pendina application for a Development Aareement with the City or application for chanae of zonina map desianation or chanae to the City's Future Land Use 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.. DYes 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 PRECED G CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDIT ES 0 COMP- SATION DURING THE REPORTING PERIOD. I do solemnly swear that all of the foregoing f s are true and correct familiar with the provisions contain in S . n 2- 82 of the Miami Beach requirements. Signature of Lobbyist: Signature of Principal/Client: d that I have read or am Code and all reporting Form of Identification PRINCIPAL IDENTIFICATION: ( tfProduced ID L. I Q,,1A.P.d R ~.;) v-:S' l' 0 S.) - 22Y ~ 0 r Form of Identification VI. LOBBYIST IDENTIFICATION: Ll Produced ID \fJ Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: D Personally known (Principal) State of Florida, County of Miami-Dade Sworn and sUbscri~e me ~ #'~ E1izabeth T~day of <Y , 20 e \1J MyComrn~oo~OO9 ifi~tr ~~A4Y//.r ~ 0) ~ ~amre of Pu6Iic Nota - State of Flori a Notarization of Principal's signature FOR CLE Annual Registration fee: [ Yes [ ] No Amo t P Lobbyist Registration Form received and verified by: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05. c SE.-QNLY ~ .UJ MCR 7/~Date Paid Revised 12/08/04 . 07-19-06 03:26PM FROM-TEW CARDENAS REBAK +3055361116 T-097 P.03/03 F-287 I". DISCLOSURE Of TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHI:R HOlJRLY, FLATRAWOR OTIfER): A) LO~8YIST DISCLOSURE: (Reqlllred) 8) PRINCIPAL'S DlSCt.QSURE (OF LoaaVIST COMPENSATION): (Required). The following information must be answered: 1) Pursuant to Miami Beach City Cexle Section 2-488 Entitled "Prohibited Campaign Contributions By LobbyiSts On Procurement Issues": $~35/~ -1{ ?:?~) Ifn't/ ent or 2) pursuant to MiamI Beach City Code 2-490 Entitled "Prohibited Campaign COntributiOns By Lobbyists On Real Estate Development !ssues": 3) pursuant to Miami Bea<;h City code 2-484 (h) My 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 noHor-proflt 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, shalt not be required to pay any registration fees.. ~es ~re you representing a not-for-profit corooration or entity without special comoensation or reimbursement. . V. SIGNATURi= UNDER OATH: ON oCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNt::D STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSAnON RECEIVED, IN THE c:I1Y OF MIAMI BEACH FOR THt:: PRECED G CALENDAR ytiAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPEND ES 0 COM SATION DURING THE REPORTING PERIOD. 1 do solemnly swear that all of the foregoing t s are true and correct familiar with the provisions contaIn in S n 2- 2 of the Miami Beach requirements. Signature of Lobbyist: d that I have read or am Code and all reporting Signature of Princlpal/Client: VI. LOBBYIST IDENTIFICATION: t:V \." FL-O FlJPA I IPAl. ENTIFICATION: lO'Oduced ID UCPA..aR PS~.. .5"'10-5,,;;- 2.. 9.J-D Form of Identification ,,~ Elizllbelh Bernardo o Personally known (Principal) !~ .. My Commiasion 00201009 ''1'"..1 ~ April 7 2007 . o Produced IO Form of Identification u Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY': FOR CLERK'S USE ONLY Annual Registration fee: ( ] Yes [ ] No Amount paid MeR # I.obbyist Registration Form received and verified by: F:\CLeR\$AL.L\MA~IA-M\Lobbyist\LOBBYIST fORM OS.doc Date Paid Revised 12/08/04