Jose M. Eliast
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City of Miami Beach Office of the City Clerk ; ~ ~ ~ ~ ~ ~'
1700 Convention Center Drive, Miami Beach, FL 33 ~A~ 2 ~
PM 5~ 14
LOBBYIST REGISTRATION FORM -.- ~` ~r^ ~'
lottryist means au persons errrployed or retained, wheiher paid or not. bN a prinapai who seeks to encanage thepa,~tl6f~af`b ~ ~ q~~n r.
arty ordnance. resolution, action or dec~on d any corrur>issioner, any aatiorr, decision, recrorrrvrrerrdation of the CAy Manager or any dry t;
corrxriittee; w any action, decision or recorrrmendauon d arry city persorrrrel doing the time period d the entire decision-melting process on each
action, decision or recomrriendetion ttrat foreseeat>ty will be turd or reviewed by the sty cortvrriesbn, or a sly board or cortnruttee. The tens
apeaficauy includes the prkrcpal es wdl as any employee engaged rn IobCMng achviues. The term "Lpbbylsts^ has speclNc aiaehrslorrs. Plasee
rNhr to Ordinance 2004d+i36.
r L I ASS 7`os C ~
NAME OF LOBBYIST: (Last} (First) (M•~
n_._>,Itr1~~Prt('~~,'(S ~KV C.JC,TVI~ 12 NE StST. M1kMl~ ~L 33l3Z
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State} (Zip Code)
(77j6) 2~8 -~S~ Zt/s~ELrASCarBrCC.soyrH .HET
FAX N
LOBBYIST RETAINED BY:
FiN out this section if principal is a Corporation, Partrtership or Trust [Section 2.82 (c)]
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
?o5E E~-l~S, ?RfS1'OItIS~
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 596 OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
II.SPECIFIG LOBBY ISSUE:
GlR~ F~~ t N Ei
Issue ~ be lobbied (Describe in detail:
iii. CITY AGENCIESflNDNIDUALS TO BE LOBBIED: (Pursuant to city code section 2.ts2(g)
include a statement of the extent of any business, financial, famiWal, professional or other relationship, giving raise to an
appearance of an impropriety, with any City personnel sought to be bbbiexl; further, pursuant to City Code Section 2-
482(ax4) include a statement of any oorttradual relationship (paid or unpaid) from 12 months preceding the
commencement of service of Cky personnel to be bbbied.)
A Fall Name of Indlvidwl Title B M Financial, Familial or Professional Re:lationshi
DLL t~A~G1'~1k-I~f cF c~-x-''~~Ac Af~i~4t23 K t~
~~j'
NAME OF PRINCIPAUCLIENT:
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
owTE OR OTHER:
A) LOb%YIST DISCLOSURE: (Required)
><I DN
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). ALAW~
The lblbwing iMormatlon must be answered:
1) Pursuant to Miami Beach City Code Section 288 Entitled `Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^ Yes l]9 No• Are you lobbvlno on a uresent or eendlna bid br epode eauloment or services or on a
present or perrdina award for Bloods. equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
M8D?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt frnrrr the definition of
"bbbyisY as set forth in Section 2-481 above) who only appears as a representative of a not for-profit
corporation or entity without spedal compensation or reimbursement for the appearance, whether direct, or
indirect, th express support of or opposition th any item, shall regisbBr with the dark as required by this
,~/ section but, shall not be required to pay any registration fees.
th Yes ^ No: Are you representing a not~or-profit coruoration or entity without special comlaensatlon or
reimbursement .
V. SKiNATURE UNDER OATH:
Signature of PrincipaUClient
VI. ~f LOBBYIST IDENTIFICATION:
~J~(1 Produced ID - '~. ~-"
JJ"~~~„ ~ ~2~ F of Identification ~ 1
"`~ -~
^ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
PRINCIPAL IDENTIFICATION:
c=a ~
JZ9, Produced ID `'1~'-~~
'~\ Form f Identification
^ Personally known (Principal)
Stafie of Florida, County of Miami-0ade State of Florida, County of Miami-Dade
Swom boa d subscribed befo Swom a subsc ' d before me
This day of J " JESSICA OZORES f
,t.• :,% MY COMMISSION i DD 677243 ;ia1~
_,:
XPIRES: May 22, 2011
Signatu I' Notary - - • • ridanaadrnrur~yPur~rcunae~w~i'iipn ure of bl ,! tary -Stet
JESSICA OZORES
MY COMMISSION M DD 677243
EXPIRES: May 22, 2011
aanded Thai Nctery P~IIs Underwriters
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid = MCR g Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\LOBBYIST\Lobbyist Registration Form 32708.doc RlYbted 03/27/2000
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familia'Ftroith the
provisions contained in Section 2 of the Mia 'Beach City Code and all reporting requirements. ~? ~
O
Signature of Lobbyist ti,
~ a
20Q9 JA1~ 21 PM
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov ~. f
CITY CLERK Office CityClerk@miamib~~~f~g~.. ~. E `~('~ ~~-F- t ~ t`
Tel: 305.673.7411 ,fax: 305.673.7254
LOBBYIST NAME: 70SF M • F G I ~S
I understand that no later than October 1st of each yg~, 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.
~ ~ i o.
Signature: Date:
F:\CLER\LOBBYIST\Lobbyist Registration Form 32708.doc