Alfredo J. Gonzalez - Enid Rodriguez IV\IMAI BEACH
Office of the City Clerk
1700 Convention Center Drive
Miami Beach, FL 33139
305.673.7411
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, 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 City Code Chapter 2, Article VII, Division 3, entitled "Lobbyists,"
for additional information.
Instructions: Please complete all sections of this form and submit the completed form,with the applicable fee,to the Office of the City
Clerk. If you need more space to complete an answer, use a separate sheet(s) of paper. If you have nothing to report in a particular
section, you must write "none" or "n/a" in that section. Any change to any information originally filed, or any additional City
Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amendment to the registration form.
The lobbyist has a continuing duty to supply information and amend the forms filed throughout the period that the lobbying occurs.
Separate registration forms shall be required for each principal represented on each specific issue.
I. L B F
SST ORMA ON:
.07 ��--
N M OF LOBBYIST (Last) (First) (Middle Name)
:',_j 3 �. L �� i kin 53 I3
LOBBYIST BUSINESS A M AND ADDR SS (Number and Street) (City) (State) (Zip Code)
305 57O5
Gbae 16\� 6-4
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
10 z �
NAME OF PRINCIPALLY (Last) (First) (Middle Name) /�
I"( r 1 �� 7 Z G�t'!�t'I'Q�—� �/ r 2G�y� Cwt e/'�
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
.35/31
305 - 67 y _ /g v" 7 Y 6- 2-12__- 7 )Zi`aQw,v�i:c w,b cc�cf .4
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS l e-r,rs-,
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided pursuant to City Code
Section 2-482(c):
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
A.//Tf^
• NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
k91A-
III. ISSUE TO BE LOBBIED:
Describe with as much detail as is practical, including but not limited to a specific description where applicable of a pending request for
proposal, invitation to bid, or public hearing number.
frAL1 114C- �''� (moi ekA- f M 6
IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4), list the City Commissioner or City personnel sought to be lobbied,and whether the
lobbyist has entered into any contractual relationship(paid or unpaid)with said City Commissioner or City personnel from 12
months preceding such commencement of service with the City to the present date, stating the general nature of the subject
contractual relationship.
Full Name of Individual and Contractual Relationship(If yes,explain) YES NO
do,u--),i
TTitlleof Person to b /Lobbied
6 . ��, �� �-
UJ o , , .���1 0y1Y1\\t
Pursuant to City Code Section 2-482(g), every registrant shall be required to state the extent of any business, financial,
familial or professional relationship,or other relationship giving rise to an appearance of an impropriety,with any current City
Commissioner or City personnel who is sought to be lobbied as identified on the lobbyist registration form filed.
List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an appearance of
impropriety:
qA
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note that a
contingency fee is prohibited pursuant to City Code Sec. 2-485.3):
z_112-0 -
The following five(5)questions MUST be answered:
1) Pursuant to City Code Section 2-488,entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues":
_Yes�[No: Are you lobbying on a present or pending bid for goods, equipment or services, or on a present or
777«< pending award for goods,equipment or service?
2) Pursuant to City Code Section 2-490, entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development
Issues":
Yes o: Are you lobbying on a pending application for a Development Agreement with the City or application
—
for change of zoning map designation or change to the City's Future Land Use Map?
3) Pursuant to City Code Section 2-482(h), any person (except those exempt from the definition of "lobbyist" as set forth in
Section 2-481)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
- ' clerk as required by this section, but shall not be required to pay any registration fees.
41 o: Are you representing a not-for-profit corporation or entity without special compensation or
reimbursement?
4) Pursuant to City Code Section 2-481, the term "lobbyist" specifically excludes the following persons: Expert witnesses who
provide only scientific, technical or other specialized information or testimony in public meetings; any person who only appears
as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether direct,
indirect or contingent,to express support of or opposition to any item; and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or
reimbursement for the appearance.
_Yes)lo: Are you providing only scientific. technical or other specialized information; appearing as a
TT�� representative of a neighborhood association without special compensation or reimbursement or
representing a not-for-profit based organization for the purpose of requesting a grant without
special compensation or reimbursement?
5) Pursuant to City Code Section 2-482(a)(4), a lobbyist who has within the past election cycle provided campaign consulting
services to an incumbent member of the City Commission shall disclose such particular service on his/her lobbyist registration
form and shall orally disclose such particular service before lobbying the City Commission at a public meeting.
—Yeso: Have you provided campaign consulting services to an incumbent member of the City Commission
within the past election cycle?If yes,please list the incumbent member(s)of the City Commission:
If yes,you must also orally disclose such particular service before lobbying the City Commission at a public meeting.
VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, FOR THE PRECEDING CAL NDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAGED TO A• :BY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENSATION` I RING THE REPORTING PERIOD.-
.' L 3�/7- / 7
Signature of Lob '1st: � �n� Date
. , o —
I do solemnly swear or - m-all o the egoing facts, statements, and disclosures in this form are true and correct,
and that I have read or am fa .r with p.'- provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
the Miami Beach City Code and all re•••ing requirements.
Signature of Lo••yist: IIIIPP:.=/ifli —. Date 3/ 7 - /7
_.. -
/0,
Signature of • . ipal: %�' - Date .-.7.-Y(7// -7
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of .,f7er'�C-- State ofPa''. de'"
County of: ►4 ;(4,141 : - Dov County of: 04 Glyn i " v`"`it"
Sworn tej*affirmed�d subspribed before me Sworn tgi(or affirme ) and,subscribed before me
this /t day of Gt.f k , 20/-?, by this �� day of g,,/L" , 20/ by
Al�r--e ckd 5 .6'antit.
En 1 J 170,4r..c u-&Z
NAME OF LOBBYIST NAME OF PRINCIPAL /
iiC
_Produced ID
vProduced ID ' � '
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
Personally Known —Personally Known
_AiAllpr,"0.-1,-;
l lorPl- ..- , '4.
S. re of Notary Public 1 Sign- .- o ,• ' -u•lic
Nam ' .. -.,TT..71.::71yr►"' .:n'l: • " d Name o L• - -_. ' '-___- ped
• MISSION#GG 030524 p v SEBASTIAN QUEIADA
I' r RAMON
(NO �'. i_ EXPIRES:September 14,2020 ( I 63`: ',y- SEmeidcbfAMISSION#GG 030524
, ?;}'
-�- EXPIRES:September 14,2020
Undovaitar+
P. /Bonded Ttuu Notary Public
TO BE COMPLETED B CITY C '- /
Annual Registration fee: [ ]Yes d No Amount Paid$ MCR# Datef4p Paid
Lobbyist Registration Form received and verified by: Se21aL •=�C
F:\CLER\BALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 08-18-16 REG.doc Revised 08/18/2016
1 The term"lobbyist"specifically excludes the following persons:
Expert witnesses who provide only scientific,technical or other specialized information or testimony in public meetings; any person who
only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance, whether
direct, indirect or contingent, to express support of or opposition to any item; and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for
the appearance.
' '- \--\
Florida 33139,W,N,N•miamibeachfl.gov
1 r14 ' ' ''' ,
'4 Miami Beach'
Center Drive, tyClerkC�miamibeachfl•9°v
i Beach,1700 Convention CityClerk@miamibeachil.gov of Miami
011ice of the City Clerk Clerk
Ra4ael E.Granada,City Clerk
305.673.7254 to
Tel: 305.673.7411, �� ��
i---1 T
TEMEN
NAME OF LOBBYIST: E AND COMPENSATION STA any lobbyist (or
LOBBYIST FEE EXPENDITURE Clerk shall notify
the City . re and Compensation Statement�) Section 2-485(d), Expenditure be imposed as p
City Code a Lobbyist Fee Exp
Pursuant to other penalties that may Statements filed after the
who fails to file timely a ny oth assessed for ommission on Ethics and
principal) In addition to 50 00 a day shall be County Statement or pay the
(Statement) a fine k $ the Miami-Dade l to file the
Section 2-485.1, Clerk shall notify lobbyist (or principal)due date The City of a lobby
Trust of the failure year, shall be
Public April 30th of each fine has been
assessed fines after notification aired Statement by paid unless the t.
who fails to file the required
all fines arePublic Tru
Any lobbyist, suspended from lobbying aural Commission on Ethics and City Clerk a
automatically Miami-Dade County I shall submit to the compensation
appealed to the year, as well as
28 of each y on which ► have
e that on February lobbyist expenditures,
acknowledge oath listing all lobby and to the specific issue
I herebyyear with reg
signed Statement under ceding calendar y
received, for the p
been engaged to lobby•
no longer 1°bbYClerk n
LOBBYIST WITHDRAWAL or 1 am Cit
2) to lobby has concluded Office of the Y
sue 1 have registered file Notice of Withdrawal with the
Once an ►s ediately a
that issue, 1 shall immediately erio
REGISTRATION FEE 12-month p
LOBBYIST RE aired for each registration shall b
3) ANNUAL lobbyists shall be required
registration of all 10 and the fee for such
annual reg Miami Beach City Code.
I understand �ctober 1 of each 82 of the
comrnencin� Section 2- 7
$500.00 p'+ uant to
,t,
�f/ Dat:
.:►st
1
\LOBBYIST FORMS\Lobbv'st Registration Form Revised 08-18-16 REG.doo
F:\CLER\SALL\aFORMS