Rene D. Gueitss
m MIAMIBEACH
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NAME OF OBBYIST: (Last) (First) (M.I)
BUSINESS NAME AND ADDR SS (Number and Street) (City) (State) (gip fie)
~ ~
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 dty personnel during the time
period of the entire deasion-making process on such action, decision or recommendation that foreseeably will be heard or reviewed
by the aty commission, or a aty board or committee. The term specifically includes the princpal as well as any employee engaged
in lobbying activities. The term "Lobbyists" has s ecific exclusions. P se refer to Ordinance 2004-3435.
~~
TELEPHONE NUMBER: FAX NUMBER:,,,,
I. LOBBYIST RETAINED BY:,~ ~ ~ _ ?I
NAME OF PRINCIPAL/CLIENT:
BUSINESS NAME AND
(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
/~ I i~lrn - '~~C/1 V L'H ltinG'i ~ 7~1~ ~~
Issue to be lobbied (Describe in detail): -Q-
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title 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 OTHERr ~, '
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
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":
t~Yes ^ No: Are you lobbvina on a Dresent or pending bid for goods, eauiument or services, or on a
present or Wending award for goods, eguioment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Este Development Issues":
aWWlication for chance of zoning maW designation or chance to the Citv's Future Land Use
MaW?
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..
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ OF EACH YEAR, EACH LO YIST SHALL SUBMIT TO THE CITY CLERK SIGNED
STATEMENT UNDER OATH, LISTING LOBE NG EXPENDITURES, AS WELL AS COMPE TION
RECEIVED, IN THE CITY OF MIAMI BEACH FO HE PRECEDING CALENDAR YEAR, AST EMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO NDITURES OR COMPENSATION NG THE
REPORTING PERIOD. _,-~ ,-
I do solemnly swear that all of the fore
familiar with th ovisions con in Section
requirements. ~--~
Signature of Lobbyist:
Signature of Principa't~Client•
VI. LOBBYIST IDENTIFICATION:
Produced ID
r and that I have read or am
of the i Beach City Code and all reporting
PRIN PAL IDENTIFICATION:
Form of Identificat~c~~lllllll/ Form of Identification
O \P ..••••.. F ii ^ Personal) known Princi al >~ f.
^ Personally known (Lobbyist \ ~~~,`~~: ~~ HATFj ~O ~i Y ( P ) ~~ti'~ ~$~I~. ~i- y j~;
\,~ o~~t,\SyyS18N~'Oi • ii .,~`~\•\~`~'1SSI0 ~• /L`~~~~~
VII. SIGNATURE AND STAMP~F•~~Y:"~~9u,'~ ~. ~ : o°~~Y Id?~9
State of Florida, County of Miami-Daley ; gOp g~~7 ' Q~tate of Florida, County of Miami-Dad~.& ; `` ~... ~ :*
Sworn to and subscrib ,before me " °~'. .•~\ Sworn and subsc bed before me G~~, y ; #DO g~7 ~ Q?
y ~~~r` _,, 1- • F`'~•, This U y ~°9 ; ~,, y~: °Q
This ~~ L da of 20'I$~ ••• tl1~ .• • •°~~ ~ da o~ 20 ~ t "
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Signature of Public Notary -State f Florida Signature of Public Notary -State of°Florida HII#'. :"`"~
Notarization of Lobbyist's signature Notarization of Principal's signature
FOR CLER ' U~F ONLY /~ ,(~~~~/
Annual Registration fee: [ ]Yes [ ] No Amount Paid J~--` MCR #~ % ~~' -~"' Date Paid
Lobbyist Registration Form received and verified by: ~~~~
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc Revised 12/08/04
Gity of Miami Beoch, 1700 Convention Center Drive, Miami Beoch, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CiyClerk@miamibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: F--L~C ~ ~~~
I understand that no later than Q~tober 1st of each yeor, 1 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 additi 'ssue I have registered to lobby on has been resolved, (am required
t mmediately notify the Clerk's Office of lobbyist withdrawal in writing.
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I~s;visai9 ~~,oa;zoos
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Date: