Jean Ortegam P~~IAMIBEACH
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 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 teen "Lobbyists" has speciflc exclusions. Pleaae
refer to Ordinance 2004-3435.
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NAME OF LOBBYIST: (Last) (First) (M.I)
l3~~s I~t use ym ~ f ~-rf" Z121 ~,~~,c Pwe ~ a m - F~oic.~i ~L 3 3 J 39
BUSINE S NAME AND ADD S (Number and Street) (City) (State) (Zip Code)
305 (013-1530 3vs (off 3 - ? O~12 r~ °J ern
TELEPHONE NUMBER: FAX NUMBER: AIL:
I. LOBBYIST RETAINED BY:
~~ M~csevrn t~ Ar~-
NAME OF PRINCIPAUCLIENT:
~v te,,,ds ~ ~1c(sevm ~ Z 121 far k- Ave_ M ~ a m I $eac~i F~- 3313q
BIjSINESS\Nf~ME AND ADDRESS ~fVumbel`and Street) _ -,(~jity) (State) (Zip Code)
/J a'U (WSJ co /~~
R: FAX NUMBER
a
or
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5°k OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
n:SPECIFIC L BBY'ISSUE
t~C ra . ~ s ~--lv~evM
be
n~
in detail):
nl. CITY A~`ENClES/fNDlVID;UALS TO BE ~LOBiBIED: 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) 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: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST CAjUIPENSATION):
(Required). -~j-'
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 lXl No: Are you lobbvinp 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":
application for change of zoning map designation or change 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 .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
~] Personally known (Lobbyist)
VII. 1 SIGNATURE AND STAMP C
State of Florida, County of Miami-Dad s
Sworn toap~ subscribed fgre me ~~f~~
This ~i `~ 'L'dav of ~~L • 20 '.~.;:'.;~°:
Si ature of Publi~IVotary -State of Florida
otarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Principal)
`~/ -l~~ArtP~r. t4~u",~3Na~~~"/'~p"~!~J r.~ 5~"~, a~'~
Klan .~.^ ~".. ~91,* tc T~F~~ C t' y pJ'~ L~ I~..f ~, t ~ ~`9~'t:>~~
t ~ s (,_ f' ~L,~1'L ti;dJ s'' MY COw.".:E3Sf t^Iv t D x57.535 i~
~ c~"~:`''s'i''~ ~ §p~~~~f lorida, County of Miami-Dad ~, ~` ~'~ ~°'y' ~4° z°1t
~ct>tlt~: 3~ty t 2L~' ern. ri. Nm,~, a~;», asp co.
r r~.~v,~,D;! d ubsCrl b fore me i~~=sa+tr~axv ~
~ ___ Y of ~~ , 2009
of Public Notate State of Florida
on of Principal's signature
''~•. TO BE COMPLETED BY CITY CL RK'S STAFF ONLY
Annual Registration fee: ]Yes [ ] No Amount Pai - •~ MCR # ~ Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registra b 1 Revised 02/11/2009
I do solemnly swear that all of the fore ping facts are true and correct and that I have read or am familiar with the
provisions contained in Section 2-4ike-Mtar~i Beach City Code and all reporting requirements.
•
City of Miami Beoch, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK OFfice CiyClerk@miamibeachFl.gov
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME: _~Q n lJ Y T~
I understand that no later than October 1st of each dear, 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, (om required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
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Signature: ate:
l~~~visa~i na_~na,zoas