Juan Carlos David/C&D Miami Real Estate, LLC~ ~~~~~ ~ ~~~ I
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
Gity 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 wmmission, or a cky board or committee. The term spec~cally includes the principal as well as any empbyee engaged in
lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 20043435.
David Juan Carlos
NAME OF LOBBYIST: (Last) (First) (M•I)
JCD Architect 1385 Coral Way, F1 33134
BUSINESS NAME AND ADDRESS (Number artd Street) (City) (State) (Zip Code)
(305) 285-4343 juancdavid@jcdarchitect.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
1. LOBBYIST RETAINED BY:
C & D Miami Real Estate L.L.C.
NAME OF PRINCIPAUCLIENT:
5767 NW 151 Street Mieani,Lakes, F1 33014
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786) 208-5709 italgic@bellsouth.net
TELEPHONE NUMBER: FAX NUMBER: (Optionaq 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:
~f 3 sS w4 s G~=~~, G,r-~ .
II. SPECIFIC LOBBY ISSUE:
Speak in front of the Board of Adjustment for 3 rear set back issues.
Issue to be lobbied (Describe in detail:
lll. CITY AGENCIESANDIVIDUALS TO BE LOBBIED:
A) Full Name of IndividuaUTrtle I B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Re wired)
none payment for LoQbbyigstS activity N1
~ B) PRINCIPAL onSpay~mU nt~Ofor6l,obTby sPtENacTt~Vity
(Required).
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 lobbying 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":
OYes 1~ No• Are you lobbying on a pending application for a Development Agreement with the City or
~~lication for chance of zoning map designation or change to the City"s Future Land Use
Map?
3) Pursuant to Miami Beach 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 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 th~
section but, shall not be required to pay any registration fees.
^ Yes ~ No: Are you representing coot-for-profit corporation or entity without special compensation or
reimbursement .
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 PRECEDING CALEND R YEAR. A STATEMENT SHALL
.~ BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURE CO PEN ATION DURING THE REPORTING
PERIOD.
nature of L byist
I do solemnly swear that a!I of the foregoin ar true nd correct and that 1 have read or am familiar with the
provisions contained in Section 2-482 of a mi ads y Code and all reporting requirements.
Signature of Lobbyist X
Signature of Principal/Client '~~
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATKN:
U Produced ID U Produced Ip
Form of Identification Form of Identification
Xl Personally known (Lobbyist) ~J Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami ,County of Miami-Dade
Swom an subscribed before A I' d scribed before me
Th' day of / ~ ' ~ of / 0 !~
`~~=~~~ ConMllixion #
Signature of Public Notary - Sta ~~ 6y N ublic Notary - Stiate of Florida
Notarization of Lobbyist's sign o bon of Principal's signature
TO~BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid $
MCR # ~- ~b gG ~ Date Paid ~ 6
Lobbyist Registration Form received and verified by:
Revised 02/04/2008
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~+"^' City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachH.gov
CITY CLERK Office CityClerk@miamibeachfl.gov
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME: Juan Carlos David
I understand that no later than October 1st of each year, I must file the following
forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
1) Lobbyist Expenditure Form
2) Disclosure Form
Failure to file these forms on a timely basis will result in my name being transmitted to the
Miami-Dade County Commission on Ethics and for code violation evaluation.
In addition, once an issue I have registered to lobby on has been resolved, I am required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
~ 11/29/08
Signature: Date:
Revsed ~~2/G4?~~~~~r,g