Esteban Ferreiro/Ameresco, Inc.~rvv+-e~-~ Sev
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City of Miami Beach Offiee ,Qf the City Clerk c-~ o
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, defeai`~ix mod,~jgation ~f't
any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the City Manager or-~y city board .cc--
committee; or any action, decision or recommendation of any city personnel during the time period of the entire decision-making proces~n suctP`
action, decision or recommendation that foreseeably will be heard or reviewed by the city commission, or a city board or com~tfee. a term..,
spec'rfically includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exc113sions..Please~ a
refer to Ordinance 2004-3435. iV
~'e"1'Z•~ 1 Yt,,v ~ S~-~ VJ And -:-, c,Jt
NAME OF LOBBYIST: (Last) (First) (M.I) ~-
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (Sta e) (Zip Code)
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TELEPHONE NUMBEF
I. LOBBYIST RETAINED BY:
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EMAIL:
BU
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r 4lG3322
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FAX NUMB R:
(Number and Street) (City) " (State) '
~6 G -' 1132 ' /2/ ~ , ~ ca.Sc1^ !~. dk~r,
FAX NUMBER: (Optional) EMAIL: (Optional)
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Fill out this section if principal is a
or
• 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:
n:S.PECIFfC LOBBY ISSUE:
h~.S~sca TJC.
Issue to be lobbied (Describe in detail):
a
ul. CITY AGENCIESfINDIVfiDUALS 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-
~t82(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
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(Zip Code)
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: jRequired) s~~
~ 3 v~ oo ~b~ +~.ron~~ ~~+~s
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). c ,e.....1s~~A, •S w.~ppJ~
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 lobbving on a present or pending bid for goods equipment or services or on a
present or pendina 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 lobbving on a pending application for a Development Aareement with the City or
application for change of zoning map designation or change to the Citv's Future Land Use
. . Maw .
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.
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: ~ v
I. LOBBYIST IDENT IC ON:
~L D~ ~# ~^
~~ Produced ID ~~c(C+~' ZDO' ?~ • .7tJ~ -d
$ ~; ~ Form of Identification
~~~.~
~~ ~ Personally known (Lobbyist)
~,~~ VII. SIGNATURE AND STAMP OF NOTARY:
`N.~
State of Florida, County of Miami-Dade
~• ~ Swom to a~ subscribed bef re me
~~tr~ This ,~_day of , 2009
•~....,,,;, ~;~ L,.
Signat e of Public Notary -State of Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
_~Prodt~ed D~ pR$(~4 x,$99' J ~R
Form of Identification ~ g
~ ~~
^ Personally known (Principal) ~~
;. • ~ ~
State of Florida, County of Miami-Dade
Swom an,~ subscribed befo a me
This day of s1P~, 2009
~~ 1~ C ~~t' ~ ~
Signature of Public Notary -State of Florida
Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ] Yes No Amount P~jfj,$ ~ d~ MCR # Date Paid / O
Lobbyist Registration Form recei d and verified by:
~: ~C~~~ s4~~it,~ `~~~oR;~~,~~~~`tt~'~ ~Cbt~~:~~,~obta~tx' ~~~is~rtavr ~.~r~x: ~ ~,~:c~.aa~ Revised 02/11/2009
I do solemnly swear that all of th mg facts are true and correct and that I have read or am familiar with the
provisions contained in Section 2- a Miami Beach City Code and all reporting requirements. '
I
City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk@miamibeachfl.gov
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME: ~,` Caae&~'S_~c (~,s-t~Da~+ ~'~Irw~,rtti
~•
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 ~otify the City Clerk's Office of lobbyist withdrawal in writing.
Signature:
~ oq
Date.
F.IGLER\LOBBYIST1Lobbyist Registration Farm 32708.doc