Brian May i
4
P AJ t A.i it
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
AKAEND6D LOBBYIST REGISTRATION FORM ((��Q> e 6f �om��y nafne)
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 2004-3435.
410-V
NAME OF LOBBYIST: (Last) (First) (M.1)
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip ode) 1
3o5 - 5461- Vuvo 3D5 - X1/5/-ll 29 @me. com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this o.ffice�f,°°your contact-information changes: address',phone, ore-mail„address
I. LOBBYIST RETAINED BY:
�eroK S+a+e, e Local �o �v�'ioNS,1r�C CFWA ACS
NAME OF RI IP UCLIENT: r.
23Di1 e4v-n �nt��r� 31yd, Tal.l�hasse� FL 3209
BUS�iNESS N E AND ADDRESS ( mber Ind Street (City) (Slate) (Zip Code)
t5�- 01 - 1330 Lu50� 201- 15q�
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:,(Optional)
Fill out this section if principal is`a Corporation,Partnership or Trust(( TSection 2-482(c)]
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: J bQ►1he d))o rLd
i
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: !
n SPECIFIG7 -WEB_ ISSUE:' 1� i 9 ��" CGmera RF P 6 2-o-2o q
Issue to be lobbied(Describe in detail):
Ill.ChTY"AGENCIES/IMDIUIDUALS TO'BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4)include the commissioner or personnel sought to be lobbied,and whether the lobbyist has entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's
commencement of service with the city to the present date,stating the general nature of the subject contractual relationship.
Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
title of erson to be.lobbied
O J 2C[ Mr-rIj_,5.J)QAe
I
Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,familial or professional
relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner or city personnel who is
sought to be lobbied as identified on the lobbyist registration form filed.
i
Sec 2-482 Any Financial,Familial or Professional Relationship
v
i
i
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
M
Prieto, Silvia
From: Mireya Carballosa [mcarballosa @flapartners.com]
Sent: Monday, May 21, 2012 4:59 PM
To: Prieto, Silvia
Subject: Re: Lobbyist Registration
Attachments: scanner@ barretogroup.com_20120521_154111.pdf
Silvia attached is the first page for the Amended Lobbyist Registration for both Brian May and Tim Riera-Gomez.
Thank you,
M i reya
From: <Prieto>, Silvia <SilviaPrieto @miamibeachfl.Rov>
To: Mireya Carballosa <mcarballosa @flapartners.com>
Subject: RE: Lobbyist Registration
I do not think is necessary as long as it comes from you as his representative.
MIAMI BEACH
Silvia Prieto,Administrative Aide I
CITY CLERK'S OFFICE
1700 Convention Center Drive, Miami Beach, FL 33139
Phone: 305-673-7000 ext.6269/ Fax:305-673-7254
www.miamibeachfl.gov
We are committed to providing excellent public service and safety to all who live,work and play in our vibrant,tropical,historic community.
From: Mireya Carballosa [mailto:mcarballosa(aflapartners.com]
Sent: Monday, May 21, 2012 3:53 PM
To: Prieto, Silvia
Subject: Re: Lobbyist Registration
Silvia, I just thought of something—do you need the Amended registration executed by the client?
M i reya
From:<Prieto>,Silvia <SilviaPrieto @miamibeachfl.gov>
To: Mireya Carballosa <mcarballosa @flapartners.com>
Subject: RE: Lobbyist Registration
Hi Mireya,
Please email me a copy of the lobbyist registration with a notation on top to read "Amendment" to change a name of a
Co. to a new name.
This way I will attach the "Amendment" to the Original Lobbyist/s registrations.
MIAMI BEACH
Silvia Prieto,Administrative Aide I
CITY CLERK'S OFFICE
1700 Convention Center Drive,Miami Beach, FL 33139
Phone:305-673-7000 ext.6269/ Fax:305-673-7254
www.miamibeachfl.gov
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,tropical,historic community.
1
'From: Mireya Carballosa [mailto:mcarballosa(�)flapartners.com]
Sent: Monday, May 21, 2012 12:08 PM
To: Prieto, Silvia
Subject: Lobbyist Registration
Good afternoon Silvia,
Instead of leaving you a lengthy message on your machine, I thought I would write. Our client ACS has changed company
name. They are requesting that we amend the name throughout all municipalities. Is there a procedure through the City of
Miami Beach in which this can be done, or is it as simple as filing a duplicate registration form with the new company name as
follows: Xerox State & Local Solutions, Inc. (F/K/A ACS).
Let me know if this is ok. If you need to call me I will be returning from lunch around 1:15.
Thank you,
Mireya Carballosa
Floridian Partners
(305)461-4260
2
T
m MIAMIBEACH
~~-n1 C ~~
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 inGudes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please
refer to Ordinance 2004-3435.
tau ~~a~
NAME OF
(First)
(M-I)
V
BUSINESS NAME AND ADDRESS ~ (Number and Street) (City) (State) ~ (up t;oae)
l~~rl ~~~ - c~2~o ~~r~-,l~~l~-1128 bmQU~?~barr' o~
EMAIL:
I. LOBBYIST RETAINED BY:
~-c~
NAME OF PRINCIPALlCLIENT:
230$ ~~i 1~ ~Ci~rl ~'Pn~r 3lud ~ a~ ~Q~QS~e~ ~~- 3Z~q
BUSIN NA E AND ADDRESS (Nu rand Street) Cit) (State) (Zlp Code)
TFI FP ONE MBER: FAX UMBER: (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:~~ ~ ~ ~ ma~~ ~ Q [~
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY ISSUE: U~ -U~JD~'
redl~i~~ ~~-~r~ ',~F~
Issue to be lobbied (Describe in dlssue to be lobbied (Describe in d il)~
Ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City code section 2-482(91
include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise tp 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 the
commencement of service of City personnel to be lobbied.)
A Full Name of Individual Title B An Financial, Familial or Professional Relationshi
O ~~Ctm2 ~®~~
~,~~
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 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":
Yes ^ No• Are you lobbvina on a present or pending bid for goods eauipment or services. or on a
present or pending award for goods. eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^ Yes ^ No• Are you lobbyina on a pending application for a Development Agreement with the Citv or V
application for chance of zoning map designation or change to the Citv's Future Land Use
Mau?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"IobbyisY' as set forth in Section 2-481 above) who only appears as a representative of snot-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 snot-for-profit corporation or entity without special compensation or V
reimbursement. .
V. SIGNATURE UNDER OATH:
I do solemnly sw f the foregoing facts are true and correct and that 1 have read or am familiar with the
provisions contained in S tion -482 of th Mi a , City Code and all reporting requirements.
l
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFIC~ATI~ON: PRINCIPAL IDENTIFICATION: -
q',' i
d Produced ID ~_ Produced ID ~~/~~ ~~~~~'
Form of Identification Form of Identification
C7 Person ,"„r,,,x, ohh~~ ^ Personally known (Prin ~~~ +y,~,~,,, MIp~yACARBALLOSA
VII. SIGNA ~ MIR~~~ ',~ .t-. MY COMMISSION q DD 839713
~~ , ~i EXPIRES: February 22, 2011 ~ ~ ga~lrn ~tyNPuW ends
State of Florida, - u"d""~fBfS State of Florida, County of
Sworn o and su Swor nd subscrib ore me
T ' d o 0(~ This day of , 20
ig ture f P otary -State of Fllorida i a re of bli cry -State of Florida
No rizat on of Lobbyist's si ature Nota ation of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid S •""'MCR # ate Paid ~~
Lobbyist Registration Form received and verified by:
F:\CLER\LOBBYIST\Lobbvist Registration Form 32708.doc ~ ,, Revised 03/27/2008
l
Signature of Lobbyist
City of Miami Beach, 1700 Convention Center Drive, Miami Bench, Florida 33139, www.miamibeachFl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fax: 305.673.7254
CilyClerk@miam i beachfl.gov
LOBBYIST NAME: l^L Qr-'~ ~~'
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.
p"~~3 ~~
Signature: Date:
F:\CLER\LQBBYIST\Lobbyist Registration Farm 32708.doc