Viviane Bressane Spinellil `T ~ $~~~r ~r~~/F ,,~~r
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City of Miami Beach. Office of the City Clerk
1700 Convention Center Drive, Miami Beach, F~(~~~ ~ g ~~ 10' 4$
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, efe t tnbd~i~
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 commtttee. 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 20043435.
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• - • -- ~.. , ,,., .,~~T. n a~tt (First) (M I)
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rii rcinlFSR NAME AND ADDRESS (Number and Street
LOBBYIST. RETAINED BY:
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rcac tionnF AND ADDRESS (Number and Street) (Ctty) (State) ~ (Zip Code)
=ill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] ..~ ~ ~"y
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NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ~ ; C ~^~
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IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP J(d'rER~T IN"~s
SUCH CORPORATION, PARTNERSHIP OR TRUST: . , ~ ,
u:SPiECtFIC :LOBBY ISSUE; C~~ri~~ i~p/C.._ u~ 20~ ~' „~:.
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Issue to be lobbied (Describe in detail):
iii. CITE';-R~~EM~IE~/IND.II~IDUAL'S T.~'BE' L!D'B~BIED: Pursuant to City Gode 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 Clty 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
personr+els' commencement of service with the City to the present date, stating the general nature of the subject
contractual cQlation. ~ ~ ` ~ .
_ __ __ _ _ .. .,_ __. ,~~_ Rt Anv 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~i:
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A) LOBBYIST DISCLOSURE' ('Required) 1
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":
present or oendina award for aoods eauioment or service~y ~~ ~~~~~" °r services or on a
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development fssues":
r,
application for chanae of zoning mau designation or chanae to the Citv's Future Land Use
Man?
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 'rF No: Are ou re resentin a not-for- rofit cor oration or enti without s ecial com ensation or
reimbursement. .
V• SIGNATURE UNDER OATk:
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the
provisions contained in Section 2-482 of the Miami Beach City Code and all reporting requirements.
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Signature of Lobbyist: ~~ ~~ ~- ~-~,'
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
roduced ID _ /,fjlt~,t1r~, ~,(,*~
Form of Identfication
^ Personally, known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOT.
State of Florida, County of Miami-Dade
Sworn to and subscribe before me
This l 9 ~ day ~f~_, 2009
~iILN G'~' _~
PRINCIPAL IDENTIFICATION:
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Produced ID +":e,
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^ Personally known (Principal) ~
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State of Florida, County of Miami-Dade ~ ¢~
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~.rx`x Sworn a subscribe
This /,~
T~ - aY 9f/ before me
~ , 2009 ~ ~
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Sigrfature of ~u lic Nota g•
ry -State of Florida ignatu o ublic-R}o e of Flor a'••-.i
Notarization of Lobbyist's signature Notarization of Princioal's signature
TO BE COMPLETED BY CITY C RK'S STAFF ONLY
Annual Registration fee: [ j Yes [ o Amount P 'd $ MCR # Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Regi ratio rm 211Q9.doc Revised 02/11/
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Signature f Lobb st '
~ ~~^,IAP~~IBEACH
City of Micmi Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: V ~ ~ ~ ~~
CityClerk@miamibeachfl.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 immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
/IJ~~
Signature:
06 t v
Date:
F:\CLERILOBBYIST\Lobbyist Registration Form 32708.doc