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Jorge Dorta-Duque (2)m MIAMIBEACH City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 T~~ 2010 FEB 16 ~~ 10: 2 8 LOBBYIST REGISTRATION FORM C S T 'r'" C ~~ fi' ~~, S O F~~ r F Lobbyist means ati persons employed or retained. whether paid a not, by a prirrclpal who seeks to erroourage the passage. defeat or modification of any ordinance. resdution, action or decision of arty commissioner, any action, declsion, recommendation of the City Marra~ger or arty city board or committee: or any action, derision or reoommeruiation of arty ah personnel during the time period of the entire deasion-rrreldng process on such action, decision or recommendation that foreseeably will be heard or reviewed by the city commission, or a city board w committee. The term speclficaly includes tite principal as well as any employee engaged in lobbying activities. The berm "L.ot~ylsts° has specific exclusions. Please refer bo Ordlnarwoe 2004-J4S5. rr ~dR.GS~~02TA-~~VE. Jv~~ NAME OF LOBBYIST: (Last) (First) (M.I) ~yQ6~~dn-Ya~~y~u4.~Qter 5~4s StU ~t~"~`sT. NtinM.i FL 3~~4~ BUSINESS NAME AND ADDRESS umber and Street) (City) (State) (Tp Code) C,3o~-~d~,1-S4o7 C3o5~~~3-~~~4;t ~nQ-.,tnr~(~~OC L LOBBYIST RETAINF~ BY: J Ace ~ V1 ~( ss , C.o ~ Ar~~t ~ ~ r NAME OF PRINCIPAUCLIENT: ~Vp MI,lsMl I~EdCM LLC /U TLAA~'TI/'. UI>:W P~tZth~2S LMT.. NAME AND ADDRESS (State) (Zp Code) (,3os~ S32-zz~~ sTz.at_iK~s?@ Rio Fill out this section if principal is a Corporation, Partnership or Trust [Section 282 (cu • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: JAC.O ~ I/LrC \ ss , ~'o P2E S t U fE} u T • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: C l~ A rr-Le S N t l 5 S. t ~ AGt~ k1 Vl k. IS.S r F 'V ~ f `~ S /L[~//1 kdh~F~ II.SPECIFIC LOBBY ISSUE: bP~~vai_ oFA 't~n.(pe~a~~y Pnr~t<<vi6 Fug 3>° ~~es LaGaY~ e~ 4zI8Coci~f~,s d~ Issue to be lobbied (Descxibe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2.482(8) include a statsment of the extent of any business, financial, familial, professional or other relationship, giving raise to an appearance of an Impropriety, with arty City personnel sought to be lobbied; further, pursuant to City Code Section 2- 482(aK4) 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 Nature of IIndividual B) An Financial, Familial or Professional Relationshi F-t ~ M PS rR.S o F ~ L.~ ti rn i vt E; goA /vU /U ~ S7q~>~ of ('~Z 0~~'-r, ~V ovr ~ ~'P N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) ~, ~~ ~ O p ~~¢~ B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ~ 3~~oD ~OVr~LLi , (Required). The following information must be answered: 1) Pursuant to Miami Beach City Code Section 288 Entitled °Prohibited Campaign Contributions By Lobbyists O~,nP Procurement Issues°: ^ Yes nl No: Ar+e you lobbvina on a on3ser~t or cendina bid for goods. eauioment or services. or on a present or cendina 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 lobbying on a cending 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 Ma°? 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 a not-for-profit corporation or entity without spedal compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any item, shall register with the Berk as required by this section but, shall not be required to pay any registration fees. ^ Yes ~ No: Are you representing anot-for-profit corooration or entity without scecial comcensatlon or reimbursemerrt. . V. SIGNATURE UNDER OATH: Signature of Lobbyistt\ _!~/y~/wV ~ ` ~..__.r ~ Signature of PrincipaUClient VI. LOBBYIST IDENTIFICATION: ^ Produced ID Form of Identification Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: ~6Ff ~'if~M~*~ Gdd iami-Dade ~~,pY O~ Qiif6fi'~t ~ artiyed re me ~ the CC r bap $ A ~+ 20~ 5 `ry'e res 0 ~'s'or n.~ Expi 4/2014 Signa`fu of u is otary -State of Florida Nota on of Lobbyist's signature PRINCIPAL IDENTIFICATION: ~ Produced ID Form of Identification Personally known (Principal) County of a~d s d befo - ~' ; Not~r Public - Stets of Fbrlda ay of ;n ~ CorrY~eion Exphes.Ier111, fit' COrttltl8SIp10 (m 5970Ci2 . _ ... ... _ _. BI- idetlarel NOtery Assn. of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes [ o Amount Paid $ • ~ MCR ~ O Date Paid C~ Lobbyist Registration Form rece d and verified by: F:\CLER\LOBBYIST\LObbyist Registration Form 32708.doc Revised 03/27/2008 I do solemnty swear that all-of tt}~ foregoing fads are true and correct and that I have read or am familiar with the provisions contained in Sectio -482 of tlie,/Miami Beach City Code and all reporting requirements. m MIAMIBEACH C'~ty of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityCterk@miamibeachfl.gov Tel: 305.673.7411 ,Fax: 305.673.7254 LOBBms~r NAME: Jo r~ ~ ~©R ~ A ~- J~ VC,~ v ~ 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 immec~' tely notify the City Clerk's Office of lobbyist withdrawal in writing. O ( l l -_ ~~ Zp 7 C~ ate: F:ICLERILOBBYIST1Lobbyist Registration Form 32708.doc