Gimenez, Carlos J.~~~ ~) l t 7 '~ t I .ua~ . s~ c
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
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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 Ordinance 20043435f ~ ' /'~ -
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~L3~134
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IvNMt OF PRINCIPAL/CLI
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BUSINESS ~JAM~ AND_A[
BY:
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Fill out this section if principal is a Corporation, Partnership or Trust (Section 2-482 (c)]
• NA OF CHIEF OFFICER, PARTNER, OR BENEF-CIARY:
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• IDENTIFY ALL PERSONS HOLDING, DIRECTL~R I~IRECTLY, A 5% OR M E OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:/,,;~ /r /~ern~a ~~nn ^~e~ ,f , i
n.SPECIFIC LOBBY ISSUE:
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IssGe fo be lobbied (De~lcribe in detail): - /
lll. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(8) include
a statement of the extent of any business, financial, familial, professional or other relationship, giving rise to an
appearance of an impropriety with any City .personnel sought to be lobbied -- further, pursuant to City Code Section 2-
482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding said City
personnels' commencement of service with the City to the present date, stating the general nature of the subject
contractual relation.
A Full Name of Individual Title B An Financial, Familial or Professional Relationship
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NAME OF LOBBYIST: (Last) (First) (M.I)
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: a uir )
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMP SATION):
(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":
present or pendinsi 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":
application for chance of zoning map designation or chance to the Citv's Future Land Use
Map?
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 No: Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement. .
SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
^ Prod ced ID
Form of Identification
,, `0 t A ®# ,Personally known (Lobbyist)
~~~p`•M VN Vi~~GNATURE AND STAMP OF NOTARY:
~~• • ~~JgS10N EkAi • •~ i
•~ ••°° Stat~'cgf~'lori ,County of Miami-Dade
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• 9,~• ;°•~es~° '~iRa~ ubli Notary -State Florida
~~ j" • • • of Lobbyist's sig re
0 Produced ID
Form of Identification
M' Personally known (Principal)
State of Flor' a, C my of Miami-QaI~1RYPTTBLTC-STATE OF FLORIDA
Sworn an crib before me .Orlando Ceb2110s, Jr.
This '1 y f , 20 ~ ,:Commission #DD708411
~•. .•~ Expires: OCT. Oi, 2011
BONDED THRU ATLANTIC BONDING CO., INC.
Signature of Public Notary -State of Florida
Notarization of Principal's signature
$ $ $ TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid $ MCR # Date Paid
Lobbyist Registration Form received and verified by:
F:~CLERI$Ai_L~aFORMS~LOBBYIST FORMS~LObbyist Registration Form 21109.doc ReVISed 02/11/2009
I do solemnly swear that all of the f~l-egojf~g facts are true and correct and that I have read or am familiar with the
provisions contained in Section 2- 2 of a Iv~i~mi Beach City Code and all reporting requirements.
m
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CiryClerk@miamibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
V!
LOBBYIST NAME: ~, < /Yl ~ tVL ~
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.
a ~- o
Date:
F:ICLER\LOBBYISTtLobbyist Registration Form 32708.doc
Page 1 of 1
Hatfield, Liliam
From: Hernandez, Myrna [MHernandez@becker-poliakoff.com]
Sent: Tuesday, February 24, 2009 12:16 PM
To: Hatfield, Liliam
Cc: Parcher, Robert
Subject: RE: Lobbyist Registration Form RE: Normandy Shores Golf Course Club House Facility (Item R2B)
Thank you Liliam, the hourly rate is $350. If you have any other questions, please feel free to contact me at (305)
262-4433, ext. 11027. Myrna Hernandez
~E~IZEfd~~' Myrna M. Hernandez
~.(~(~ Legal Assistant to:
~~=i~~~s~n^~~~~~~~~ Government Relations
Becker & Poliakoff, P.A.
Alhambra Towers
121 Alhambra Plaza, 10th Floor
Coral Gables, FL 33134
305.262.4433 Phone
305.442.2232 Fax
MHernandez@becker-poliakoff.com
www. becker-pol iakoff. com
From: Hatfield, Liliam [mailto:LiliamHatfield@miamibeachfl.gov]
Sent: Tuesday, February 24, 2009 12:14 PM
To: Hernandez, Myrna
Cc: Parcher, Robert
Subject: Lobbyist Registration Form RE: Normandy Shores Golf Course Club House Facility (Item R2B)
Good afternoon, Ms. Hernandez,
We are in receipt of Check No. 1535352 for $150 along with the Lobbyist Registration Form for Carlos Gimenez.
Upon reviewing the form, it was noticed that there was no specific hourly rate.
Can you please send the amount?
Thank you.
~I~I~I7~-
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Liliam Hatfield, Office Associate V
CITY CLERK'S OFFICE
1700 Convention Center Drive, Miami Beach, FL 33139
Tel: 305-673-7411/ Fax: 305-673-7254 J www.mamibeachfl,yoy
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant, tropical. historic community.
02/24/2009