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Esteban (Steven) Ferreiro3 I ~+~` ~' ~~ ~ City of Miami Beach Office of the City Clerk A~ 9~ 51700 Convention Center Drive, Miami Beach, FL 33139 ~~~~ ~11L 15 ~~ ~'~ `t ~~•-~~ LOBBYIST REGISTRATION FORM s. ~~~,~ ~yistt`~•, o 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 speciflic exclusions. Please refer to Ordinance 20043435. NAME OF LOBBYIST: (Last) (First) ~ (M.I) ~ Coac~lJ'r~ ~`t~C' /~~~ 5 W /yf~C~ ~--~,a.~ ; ~ t- -~ 3/gb BUSINESS NAM AN ADDRESS (Number and Street) (City) (State) (Zip Code) 3~S -3x~- ~ o y6 3~.s- 93 ~r- a~36 .s~ ~ >a~eo~ ~~.tx ~o ti. TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: ~oLy1 i iON CONS7~uC TON, ~Ne NAME OF PRINCIPAL/CLIENT: ?9S5 ivy is szy, ~ ~5 ~o~eAL ~L 33/--?~' BUSINESS NAME AND ADDRESS (Number and Street (Ci ) (State) (Zip Code) ~g6, 6a 1. X550 _ `786, 521. ©77~ 'cl@so/u+; o~constr~+~-Fio~ ,nom TELEPHONE NUMBER: FAX NUMBER: (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: • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: u.SPECIFIC LOBBY 1SSUEa -~ v Issue to be lobbied ( scribe in detail): nl. 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 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 n'~ A~,1 ~ ~- Ne,.1 may ~~. ~. < <, C~`~-y ~~w~ ~1~~~2 .~ ~~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): ~ A) LOBBYIST DISCLOSURE: (Required} ~ ~ ^ O ~~~ B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COM c SATION): (Required). .,;~ °~ tr- its ~~ ~: E~ 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 lobbving 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": ^ Yes `ENO: Are you lobbying on a pending application for a Development Agreement with the City or application for change of zoning map designation or change to the City'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. reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1sT OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: ^ Produced ID Form of Identification ,~~j t'~ Canr»~ssurl ~~25; PRINCIPAL IDENTIFICATION: Ll Produced ID ~'~P.ac~a. ~(rPL`S U~1YC Form of Identification ~FClaot~-~-7~7Z-o Ny C~.r,w.,rss.~a ~Q•es_ Personally known (Lobbyist) b~we~ ~~~~~~pp~~Nry ^ Personally known (Principal) '1pt~•'P~`Y/~ IYII'Y71~7NL SPRY P~ VII. SIGNATURE AND STAMP O,~ ~ ~YIrIVCOMMISSIONtDD871438 2°:"',~~, MARISa-FERNA~Z EXPIRES: April 7, 2013 * * AIY COMMISSION # DD 871436 State of Florida, Count of Miami-Dade ~'s~~°a`A! eondeaTMro9uepdN°~(if Florida, County of Miami-D o~ EXPIRES: April 7, 2013 Sworn to and subscribed before me Sworn and subscribed before me 'FOFF~°P~ T~~Y This ~`N` d y of ~ , 2009 This ~ da of c~ , 2009 Signature of Public Notary State of Florida Signature of Public Notary - tate of Florida Notarization of Lobbyist's signature Notarization of Principal's signature BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes o Amount Paid $ o1c~ ~ ~"U M # ~ Date Paid __~~ Lobbyist Registration Form recei ed and verified by: ~ ~~ ~° s ~. tC~~ t~A~-~ ~a~~~~'~~-~s~~~~~~ Fo6t~4,~ob€s}tis` ~ee~ista•~ticrs ~-rsrrn ~~.at ~.c~c~° Revised 02/11/2009 I do solemnly swear that all of the fore o' g facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-48~(o Miami Beach City Code,~1 all reporting requirements. a'' I ~,, a ~~ q City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Tel: 305.673.7411 ,Fax: 305.673.7254 LOBBYIST NAME: G"s.~~~6~.~ ~~/~-~Z CityClerk@miam ibeachfl.gov ~ ~~,~rcvz~~_ ~~. 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, to immediai >nce an issue I have registered to lobby on has been resolved, I am required ly notify the City Clerk's Office of lobbyist withdrawal in writing. Signature: 1 `~~ Date: F:\CLER1LOBBYIST1Lobbyist Registration Form 327U$.doc