Grace Calvani/MB Latin Chamber of Commerce
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MIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
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LOBBYIST REGISTRATION FORM
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Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage: ~feat._,
or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommeAdation:.Jlf the......'
City Manager or any city board or committee; or any action, decision or recommendation of any city personnel d~r.ihg tllW.time
period of the entire decision-making process on such action, decision or recommendation that foresppably will be heard or revi0\wd
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NAHt: OF LOlJ[;Y1ST: \Li..oL) (I "O\}
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TELEPHONE NUHBER:
Ft., : ;UlVIBER:
I. LOBBYIST RETAINED BY:
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II C!..fo.mber sf CtJrnIYJeJCe..
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BUSINESS NAME AND ADDRESS
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(State)
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(Zip Code)
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TELEPHONE NUMBER:
(Number and Street) (City)
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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: (0 {lAce Qa..,tuq /),,"
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR IJDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: 71 t a..
II. SPECIFIC LOBBY ISSUE:
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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
{jell l;~rrL C d::J of Cfn,
"71 0 n e...
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). em
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The following information must be answered:
Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
D Yes ~ Are you lobbvinq on~sent.gI"..Q.endinq bid f()L9...<!.()d~...gg!lJ(>!!!'?_ll.t or s~0c;~sL9.~IJ.J!
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DYes
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ZteA::v:~::~~;i::::: a pendinga..QplicatiQD.]()r:a_D~~LoQ...I1!,?_ntAqrf"cfment with thf> City or
'Wlliication for cildnye of zo .. '" ,. ," t. __~___
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"lobbyist" as set forth in Section 2-481 above) who only appears as a representativ2 of a rlOHo:-profit
corporation or entity without special compensation or reimbursement for thC",'!1CJranc:e, whC'>hcr direct, c:"
i:hjirc.:c~, ~~,.J L/f-jj"~~':';J support of l,,', _I j 1 'f __di>..U i i -'1-'"
section but, shall not be required to pay any registration fees..
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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 EXPEiblfURES, AS he:' A1 C .JHPENS. T ,'~
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATfi-1ENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATh..,oj D~k.J.NG THE
REPORTING PERIOD.
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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. ~
SignatureofLobbylst: ~ :~. r~ ll( !1J!,[f!Q.,
SlgnatureotPnncipalfOient: ~~ ~~,; B~_~.,j HKLer'rk
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
~.
., Produced ID
rA Produced ID
Form of Identification
~SOnaIlY known (Lobbyist)
Form of Identification
~SOnaIlY known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
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State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade..c . ~~D0335Ieo
S rn to and subscribed before me Sworn and subscribed before me ....~ Expire,Augu.t
T s ~~ daYOf~~~ ,2~ K818AS, RUlz This~dayof h~o'&-\- ,20Q1, 31.2008
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Slg ure of Public - State of Fonda Signature o~otary - S~Of Florida
Notarization of Lobbyist's signature NotarO ati of Principal's signature
FORC
Annual Registration fee: [ ] Yes [ ] No Amount
Lobbyist Registration Form received and verified
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Date Paid