Esteban Ferreirom MIAMIBEACH
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 term "Lobbyists" has specific exclusions. Please
refer to Ordinance 2004-3435.
U`
NAME OF LOBBYIST: (Last) (First) (M.l)
~'R ~~ c-~.0~-5 ~ tic . (f ~b'~ ~ ~ ~{~~- ~.~,,...,"~~ Wit., ~3~~`~Y~
BUSINESS NAME ND ADDRESS (Number an Street) (City) (State) (Zip Code)
c' ~ ~ -~/f11--/~2 ;~3- ~~ - O z,3.~ ,;~ y~,Q~ ~2 Co•.~c~~''~.S ~%~. cam.
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT:
c
FI8 Y tc~,l.a~cl, CG~~MQtr~ 235 Ca-~-lo vi ~~, I~{y ~ Co~~.1 C~t~(e5~ F{., 33 l 3~
BUSIN SS NAME AND ADDRESS (Number a d Street) ~ Ci ) (State) (Zip Code)
j3r~~El ~kL [ - ~ Zbo 0365 S - I l ~s~
TEI EPE~ONE NUMBER: FAX NUMBER: (ODtlonal) 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 ISSUE:
(~- q ~ ~~
Issue to be lobbied (Describe in detail):
iii. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(g) 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 preoeding 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 Rehtionshi
~ ~nn+~.~ \/5 ~ ~ ~S
V v 'r~ ~~
~~
s
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ,r-~~ ~ ~~~~ ~~ !D~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(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":
^ Yes ~o• Are you lobbying on a present or pending bid for goods, equipment or services. or on a
prosent 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":
^ Yes ~ No• Are you lobbying on a pending application for a Development Agreement with the City or
application for chance of zoning map designation or chance to the City's Futuro Land Use
Maps
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 comsensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of Principal/Client'
VI. LOBBYIST IDENTIF
IDENTIFICATION:
® Produced ID ~' ~_ (~'" ~~'~' a~'• ~L -jC~~ `v It~T Produced ID ,;~ (:,~C~C~ ~ (,? ~.~ -li., ~-~ _ ~~ 3~- D
Form of Identificati `NliillUillJJ/J Form of Identification
~,,,~~\~p,M R+ HAT~%>,.or~ ~\~,1~It1i1M101~11i11////~~i
~~ `'°•`~M~SSION~ • ~O r ~``~~ ,,\\-~(~.... HAT,c ~iy .
^ Personally known (Lobbyist) .~ ~o oarY t8 -~~,~ ;° ~~Personally known (Principal) ~~ ~ •~MMISS/pN ~~F
VII. SIGNATURE AND STAMP OF~IbfiARY:•.• ° ~ a
... _ : ;"vim,;
2 ~ #DD 832367 ° ~e ; ° ~ ~ ; +~
State of Florida, County of Miami-Dade ~~9 ~; :a Badeaw~ ~~~;~ ~~t~'te of Florida, County of Miami-Dade ~ 9; #DD~67
Sworn to and subscribed before me ',~9~A ;;~bticundB;:°•F~„~tivorn anti subscribed before me ~ A'~~y~m,~, ~,°; o~i
This ,~`~'~ day of ~, 2009 //i/f ,~~~ ~}STA ~ ~~~ i;~.~'~his day of ~ ' , 2009 ~~ii~~,e~7c STAUTE ~°~dOQ,\
`-~u~-c-G'L%~~' ~i~ ~5~--~L~~~ ~'~`f,..C: t.'L~. rx~'G-'Z47`-"tisx5w'"~ ~7j~J/1l111i1416\~~~
Signature of Public N ry - S to of Florida Signa ure of Public Notary - Stat of Florida
Notarization of Lobbyist's signature Notarization of Principal's signaturo
TO BE COMPLETED BY CITY K'S STAFF ON
Annual Registration fee: [ ]Yes [ ] No Amount Paid S '~ CR # Date Paid
Lobbyist Registration Form received and verified by:
F:1CLE~2~~at~ IaFC~Rt+151i.q~~YY~°t FCeI2hR5~Lobbyist Stegistrataan Firm 211~9.d4c Revisal 02/11/2009
I do solemnly swear that all of the forg~q{yig facts are true and correct and that I have read or am familiar with the
provisions contained in Section 2-482 g Miami Beach City Code and all reporting requirements.
m ';^,i~~ i~iBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, vsww.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: ~~~~ ~ °i~
CityClerk@m iam ibeachfl.gov
~~~€~ ~~
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 imme i ely notify the City Clerk's Office of lobbyist withdrawal in writing.
3 2 8~
Signature:
Date:
~;t ~ r< ? i£i'•'I~T'iLC3E3$~yist ~e , i~ ; ,' >sa ': orre~ 32701$.dac