Esteban Ferreiro/Imperial Parking
m MIAMIBEACH
City of Miami Beach Office of the City Clerk ZOQ9 SEA ! ~
1700 Convention Center Drive, Miami Beach, FL 33139
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LOBBYIST REGISTRATION FORM ~" r ` i ~ ~ ~; ~ , ~ ~ ~ 4 ~ &. ~ +_,,
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 inGudes 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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NAME OF LOBBYIST: (Last) (First) inn n
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BUSINESS NAME AND ADDR SS ( umber and Street) (City) (Sta ) (Zip Code)
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FAX
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
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FIII out this section if pr opal is a Corporation, Partnership or rust [Section 2.482 (c)1 `
• 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:
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Issue to be-lobbied ( esrrihe
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I. LOBBYIST RETAINED BY:
Ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City code section 2-4s2(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 Clty 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.)
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
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A) LOBBYIST DISCLOSURE:
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATI N):
(Required). /Cro-i.~. Q~5 ~A~ y~~
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 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
a lication for change of zoning map designation or chance to the Citv'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.
^ Yes ~NO: Are you representing anot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
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Produced ID r~' 2~ - 7~ • ~~ -C7
Form of Identification
PRINCIPAL IDENTIFICATION:
~roduced ID L 2/ 67~U0 '70-0' U
Form of Identification
^ Personally known (Lobbyist)
^ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to a,~subscribe bef a me
This day of Og
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
TO BE COMPLETED BY
Annual Registration fee: [ es [ ] No Amount Paid ~
Lobbyist Registration Form received and verified by:
F:SCLER\LOBBYISTeLabbyast Registration Form 327Q8.doc
State of Florida, County of Miami-Dade
Sworn an~,,subscrib d be re me
This /~' day of 2 g
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Signature of Public Notary -State of Florida
Notarization of Principal's signature
Paid
Reviser 03/27/2008
I do solemnly swear that all of f egoing facts are true and correct and that I have read or am familiar with the
provisions contained in Sectio of the Miami Beach City~ie and all reporting requirements.
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK O(iice
Tel: 305.673.741 1 ,Fax: 305.673.7254
CityClerk@miam ibeachfl.gov
LOBBYIST NAME: ~~ ~i~ ~G`,yZ,-/Z,~j ~~j
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, one an issue I have registered to lobby on has been resolved, I am required
to immecljat~ly otify the City Clerk's Office of lobbyist withdrawal in writing.
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Signature:
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F:lCLER1LC}1313Y6STllmobbyist Regis~ral:ior€ ~orrr~ 3270~.tioc
Miscellaneous Cash Receipt
C1TY OF MIAMI BEACH
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No.
~ Cash relit Card ^ Check #
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Received of ~ ~?~5~/Z ~~~~ .--.~`"'/nP~yYI ~~~n ~i!) 20~_
Address ~~ ~
For
(THIS INFORMATION MUST BE COMPLETED)
Account Number: ~~~~ ~~3~g_~-!/ ~1~
~reparer: '-~! I
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Office
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