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Michael A. Hernandez/Leroy Griffith, Club Madonna~ ~~~~ ~ !`;;%~, I ,,~~!~,~., City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM c'' ^' ra 0 Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat or-a)odificbABn of -1 any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the City Manager or ar~y,city tfc~d or committee; or any action, decision or recommendation of any city personnel during the time period of the entire decision-making ~cess Ouch '~ j action, decision or recommendation that foreseeably will be heard or reviewed by the city commission, or a city board or comm~e. Th term..--~ specifically inGudes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclu¢~ons. Please' refer to O_ rrljp~ce 20043435. ;.` N ~Wt NAME OF LOBBYIST: (Last) (First) (M.I) -. ~ f I $aGseY~t Qowtwtk~ic~~ioa5 361:3 S.kJ. 8 it. >IfZOO r~t;~.~ct.i FC. 3313Sj-~ ~~--~' BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) ~(ZipCede) .IZ'lZ a LOBBYIST RETAINED BY: LeVa~1 br~~ NAME OF P CIPAUCLIEN' b YVI~tAov~v~~ ~c r~a ~t VtG~ I S 2? Gnu sh i h a~~t-a~t .ND ADDRESS (Number and Street) (City) FAX N e, V~ is w<< ~3ltc~t ~ FL 33f 3~' (State) (Zip Code) (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. e Cin o~ G~ h ,t G Jec+icK ~-4o a e 64;sN wl,~k Issue t be lobbied Descri a in eta ~!'0 SGrV t,;p o{. G gCVt/'ac GJ III. (Pursuant to City Code Section 2-482(9) include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise 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 the commencement of service of City personnel to be lobbied.) A Full Name of Individual Title B) An Financial, Familial or Professional Relationshi L'o~crv~sci ~s ~- YV~~' Na~^-~.- ~;~r-~- V{~t utia ~ '^ e,-,-y-. s~ ~ . !. c~1N i~NRI /r~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) ~a i ~~ , Ate, B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ~' Y ~ V (Required). c~ ~ L G The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2~i88 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": ^ Yes ©No: Are you lobbying 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 ®No: Are you lobbvina 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 Maa? 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: ig ure of Lobbyist 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 2-4 of``theQM~iami B ch City Code and all reporting requirements. K.'6 ~ ~ Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: ^ Produced ID Form of Identification Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF State of Florida, County of Miami-Dade } ~; Sworn to and subscribed befor me $ ~:~ This ~ ..~.-.day-e~~_ , 208- `~.,.. PRINCIPAL IDENTIFICATION: ~ Produced ID Form of Identification personally known (Principal) ABEL""r P~~LO •+•• C~m~~d17e89fjda, ounty of Miami• Expires N ibed befo a me Balled 1hm T~,..~ M,..6..-._ C ....~ n. Signature of Public o ary - ate of Florida mature of Public State of F Notarization of Lobb ist' ignature Notarization of Principal's signature ABEL P. LOREDO Commission DD 702800 Expires November 2U, 2011 eorwea Tnn, troy r•.,, ww,rwier ba31!~1b1g '_~' City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, vaww.miamibeachfl.gov CITY CLERK Office Tel: 305.673.741 1 ,Fax: 305.673.7254 C ityClerk@m is m i beachfl. gov LOBBYIST NAME: W~1C~lk~ ~~ NPX/laly~d~G~ 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. ~. ~ j ' ~. 31, o Signature: Date: F:ICLERILOBBYIST1Lobbyist Registration Form 32708.doc