Alexander I. Tachmes/Pedro Munillam MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION RORM
Lobbyist means all persons employed or retained, whether paid or not, by a prindpal who seeks to encourage the passage, defeat
or modification of any ordinance, resolution, action or derision of any commissioner; any action, derision, recommendation of the
City Manager or any dty board or wmmittee; or any action, derision or recommendation of any aty personnel during the time
period of the entire derision-making process on such adios, decision or re~mmendation that foreseeably will be heard or reviewed
by the dty commission, or a city board or committee. The term spedfiplly indudes the prindpal 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) (Rest) (M.I)
S~v~S~-,Q~t(~ULLP x.01 S. ,~tSGA~.I1~ ~is~ ~.~~r>ai ~ ~~1~I
BUSINESS NAME AND ADDRESS (Number and treet) (City) (State) (Zip Code)
3 DS _ . 3 S~1- ~, ~nr~ 30 5 - 3 ~ i - 9~- 8L ~t t ~-~.~t-m. ~ C _S ~-v~ , cv -lam
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LO((~~BBYIST RETAINED BY:
1-~E~D(~ ~.UN-(1h
NAME OF PRINCIPAL/CLIENT:
(~~~.~. k~- fVl AG~llb~l (i~us-rin,err o~ ~v ~ D 1 S~ ~~ 5T ~111~-~.I` F-L .~3 f ~3
NAME AND ADDRESS (Number and Street) (Gty) (State) (Zp Code}
3 ~S 7 t/ ~- ~ 0(>c( 2~,5 • "' ~ ~ • ~l '~'"7 ~ ~ ~ t 1 N t 1 1 A e ~~+n ca2~. LO M
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 01MNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
.~"t3 ~ - G'Y9'O ~
Issue to be lobbied (Describe in detail):
IIL CITY AGENCIESJINDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title ~ B) Any Financial, Familial or Professional ReEationship
8
` IY. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLQTRATE OR OTHER}:
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A) LOBBYIST DISCLOSURE: (Required} o~-~U ~ ~S 17~r YIOt)T ~'~Gt °L
d (~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required)._ _ a-DD '- LP ~.~ - DAP ~ n~:%
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":
Yes ^ No: Are you lobbvina on a present or pending bid for goods, equipment or services, or on a
present or pending award for goods, equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes ~o: Are you lobbvina on a pending application for a Development Agreement with the City or
application for change of zoning map designation or chance to the Citv`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 anot-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 deck as required by this
,,sfection but, shall not be required to pay any registration fees..
^ 7~0: Are you representing anot-for-profit corooration or entity without special compensation
or reimbursement. .
Y. SIGNATURE UNDER OATH:
ON OCTOBER 1~ 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 EXP DITURES OR COMPENSATION DURING THE
REPORTING PERIOD.
gnature of Lobbyist
I do solemnly swear that all of the foregoing facts are~~tru~e and correct and that I have read or am
familiar with the provisions contemn in^Secti~ 2~~l1?-Qf the Miami Beach City Code and all reporting
requirements. (( ,~ ~~
Signature of Lobbyist:
Signature of Principal/Client:
YI. LOBBYIST IDENTIFICATION: ` PRIJNCIPAL IDENTIFICATION:
^ Produced ID z ^ Produced ID
Form of Identification o Forrn of Identification
~'- ~ MELISSA MARIE DELGADO
^ Personally known (Lobbyist) ~ o ~ ~ Personally known {Princip ~!'•".~~ MN COMMISSION #DD541827
EXPIRES: APR 18, 2010
VII. SIGNATURE AND STAMP OF NOTA~~~ ~. ~ „~
~ ~„ ~. ~--~ n Bonded through 1st State Insurance
~.~ Fn
State of Florida, County of Miami-Dade ~ ~ ~ ~ ~ State of Florid of Miami-Dade
Sworn to and subscribed before me ~ td ~~ Sworn a s scribed be re ~-~t
~ry, ,,day of l~foven /6e~/~,~2~0~a~~ ~ ~ a ~ ~ This da of 20 ~' t
~i~/ rG~t YF~~~/1.L.~~ m t~ ago ~ O
rD
Signature Public No ry -State of Florida ~' o ~ ~ a Signature of Pu o -State of Florida
Notarization of Lobbyist's signature Notarization f P ' cip signature
FOR CLER C'S U E ONLY ~1 )
Annual Registration fe~ ] Yes j ] No Amount Paid MCR # o`~/ ~~ Date Paid
Lobbyist Registration Form received and verified by, `i.Sa ~(
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc Revised 12/08/04 i