Roberto Sanchez, III/Magnum Construction Mgmt Corp
m MIAMIBEACH
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, deasion or recommendation that foreseeably will be heard or reviewed
by the city commission, or a city board or committee. The term specifically includes the princpal 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)
BUSINESS NAME AND ADDRESS
3~~- 7,9~f~?O
TELEPHONE NUMBER:
(First)
7Sz ~~l.e~ne Rd, s~,~ 63~
~'~ ~1.~~-lS
FAX NUMBER:
I. LOBBYIST RETAINED BY:
1hag~~m C®r~Sf~'~Cf~~n ~naq~~,~~~- ~a~
(M.I)
~-,4~i~~ ~L 3? ~~
(Zip Code)
~r~,a,w5"fit ~~~.CcYJ,
NAME OF PRINCIPAL/CLIENT:
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code)
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:
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
fi.~-~ ~~.e~ ~~ y~
3o~wh X01 f~~ / carhn,,z5*,~r ~,n ~
~ TO ;n jGon+~a3Si~ f /
fleL°e~G I~~'~dr~ / CO11t71.6jf ~7' /
~+ ~r S~rh~~ ~O'Y~1A/ S y /
,c - 7 ~l~~o~/ Cctl'hJh~,ji~
N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required) r~ ~)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). v ~D~ + ~~/
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":
present or Dendino award for goods, equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled'~Prohibited Campaign Contributions By Lobbyists On Real
Estat,~ Development Issues":
application for change of zoning map designation or chance to the Citv's Future Land Use
Ma°?
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 clerk as required by this
section but, shall not be required to pay any registration fees..
^ Yes [3~IVo• Are Vou representing anot-for-profit corporation or entity without special compensation
or reimbursement. .
V. 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 EXPENDITUijE~ OR COMPENSATION DURING THE
REPORTING PERIOD. / ~~/
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 ' ecti - o Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Lobbyist)
^ Produced ID
Form of Identification
personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn t an .~ub~"ibe before me
This i~f a~,moBE,Q9~
State of Floridtly of M
r~~~ MELlSSA'MARIE DELGADO
:.:~~Y ~~~~ MY COMMISSION #DD541827
Signer re Pu I'c Not e o 18, 2010
Notarization of~bbvi ig~~~ugh 1st State Insurance
MELISSA MARIE DELGADO
MY COMMISSION #DD541827
IXPIRES: APR 18, 2010
Bonded through 1st State Insurance ~
of Pu c otary -State of Flor
:io f Pry cipal's signature
FOR CLERK'S)JSE ONLY n
Annual Registration fee: [ ]Yes [ ] No Amount i ~. v MCR #~9~9 S~ Date Paid `3 D'/
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc Revised 12/08/04