Rosario Kennedym MIAMIBEACH
City of Miami Beach Officeof the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORAA
Lobbyist maerre es portions mrycoyod or reh-mect, vrtteltael psmn or rat. br a pnrz~l who saer®m encaaags tl-e psaaap0. delbat or niodtAeaUOn ai
any ordlnanos, resotudon, aWon or detislon d airy eommtastarer, any erdbon. deasian, ~ o< Oro GH. ~ anY dty Doard n
oamru~cee: of Any action, Qeomlon or remmrnendauan of any utY personnm Qtafrrp tM tams psdotl at the ~9 prooass on such
aellcn. deWbn Ot recarurtertdetlon that will be heard or reviewed try the oily COYrlrni39fOn, or a oty board or aarrnittea; The term
speanauty. uochoges me' priraipsl as well as any employee erggapeif to Iobbytrtg~acloMdsts. Ths ttnm •L.o6byNts° fie sper:Nk erorlrwlwre. Please
rMsr b Ordlaateea 2004,S43ti. ~~
TELEPHONENUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
8'trd • 8Vo • 0 7 ~rD
FDI out tithe section if prinNpal is a Corporation, PaRnership or Trust [8ectlon 282 (c)]
• NAME OF CHIEF OFFICER. PARTNER: OR BENEFICIARY:.
• IDENTIFY ALL PER30N3 HOLDING. DIRECTLY OR {NOIRECTLY, A 596 OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION; PARTNERSHIP OR TRUST:
u.SPECIFIC LOBBY IS$UE:
_~/e.lt Tisi~l ~
IBSU@ to be tobtfied tDeserlbe In detain:
lu: CITY AGENGIESlINDIVIDUALS TO BE LOBBIED: (Purauarrt to ctty code SeCthNt 2-as2(g)
Include a stralsmertt of the exfertt of arty business, financial, tatnllfal, professional or other rolatiortship, ghdng raise to an
appearance of an Improprfsty, twlth any City personnel sought to bs lobbhtd; further, purttuartt to Ciiy Code Section 2-
48Z(a)(4) InGudo a statement- of any contractual rataflonship (paid or unpaid) .from 12 morrtlts preceding the
commencement of sertrhe of Chy personnel to to leabled.)
_A) Full Name of Individual tie .~ _ ~ ~ ~B An Flttartel Famlilafor Profasalorral Relatlormhi
O~G /~ +'I~~~ ~0 ~/GVL ~/~
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t'J, DtS,GUChYURE OF T1:RM5 AND .AMOUkT:;t pF I.Ot'&YtST C4hgPL•NSATtON ;t?ISCL.OSE WHETHEF HOURL ~ FLn r
na "~ OR OTxER1: I
...~-...L' toGw ',',`r^~1,~(R~~R-• ._~/1- /h~0111'J~-
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Tfic fallp~
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irrformatton mutSt h0 an3wcrcd:
, ~ F~~•sua-n ;C nttwr,.t t3E~6Gt ;;ii • C:Ut7N ;isrian 2-d 8 Enct:ttl `?rOtib ~d C.~,rl'• art r y ~y i.LL•t?yl.. q
6 n V2ie C4rItrIJJt1~:1 a'.
C)' Rrpr7,trn'^2n1164!:5`:
;,_ Yr+s ~ Via; are you tala9vtina c~Ut„gl arosant or~nd7nq bid_Sr aooas. eav! nterttAr serv',c@v,,,_qr on a
g-e8fnt or nantilng award for goodR ow(oment ar aervlcg~
i ~'`JfS+.l~f.t :d tult~nt, 138nc" Cib~ GcNn ::.!i4 6r:;;icd'aCah rl;Wd Cnvn~e~gn C:rn:tau:~r-~ t3v Lo:Cyia;n ir•
R?8' Es;1tf.+ OevElorr:aal t:~yu9x'
' YVA •,~. No: Aro You IoELv7r,n on tt Dondlng anAllt,~Un, o-tor d ~rnEtoumrnt Aureerire,ri v.ith the Citr yr
x~tietitfpn for cfianafi o1 xonilig~ dvMtnnation or ehanaa to the Clp/s Futurr l.ond Use
MA,~7
:; >'u•5::~rrt to PdiB'ti 8ebt:n Gt;+ t:rli~ ~-cgt !~ A:7y p.&ryv^. thrcrpt trt~r: e•xevrtpi kor. tr.R nel;tfticn pt
'Igh!:Vic;' as s,e! toRn m 5e~•tit.`n :-t3' a!•rcwer wilo only ap5pars 05 a 1+greser,(ettve ^.! a not-tCr~:•a1i!
t~utGxa:tctn G- anti'p wii'+GUt S,CG~I ..Itlaensalt.n nr rob~lt;uTBnPni fp: F.Q. ,;p~3'3t1GC. whi:tElir dir>:tt v,
i'I d;rCpt, tv rep,C7a. >SUP;,pn (:' Cr GCpD,itiU~ 1C any :;cn; shall reG_:z:r,: wdt, the glR,rY. c'.5 rg yt„~!r>?;; `ry CtiS,
.action but, 9`tty~l t:cl he rc,c7ulrac:.0 rah any reglsiratipn fyNy
yr. ~ ~o• Are vyu nsy*i+aenttna a not for profit 4orporaUon nr antrry wttrout aperlat comlaPnsarapn or
ralmburscmcnt. .
51GkATURi: UNDER gcrw:
v-. t_OCDYIST IDEFITIPICA71pN~
"~r~(1Ut'F-Rj tiJ _ _
r ~`etau• bil;~ <~avrn (lehttyictf
Vtt. SIGNATURE aN0 STAMP OF NGTARY:
PRINC1YAl IUEf~ f ti^I~:QY1C}N;
yi utlu~xVJ itj
~ "PfRA,'1 Ails t'ry,:n (Pr(nc(palt
S:;ara at ::r1n_a, ~6u^ t of t/~;crn:-C`aCn OE, G~,tn;y pt Mi~n!•Cat7P.
~,vun 1 3 ~ e. y : Stitt: ui r:o:t
Q r•_ +t$Glt,EQ t72•L't~ "t!` ,j~4+L,111 a~J :tt:tts•• ' •1 •e to
j` r ~al~itlL~~y r urn tv •DI f7w'~o / !j..~C~'"~!,• Nu i P. :not
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Notarization a( 4i
"r,w!,':r}~' y !w yrktfd~ ~ ~c~r~tR!:'}?,,,.'l;'\'N;4k'diti7AroL.~tr.
DL£TEO BY CITY CL_RK'S bTAFf ONLY
gtstraGon tee: ( j Yot< ( ) No Amount Patti 5 MCI; ~ Dam paiA'
` LoDby~t Reniffilration rotTtt rseolYAtl antl voritivst by ~~ - Y` ' -'-' I
-.----.`..__~. Reviled 03/x7/2008
I^.A 5¢:emntp 9~+v6, L•re: nti of • ctn f;,.-;,
~ : tray. e:,+. vw,revu: grrl t-r:f: 1 ha•.•t! rggd ;>t' 1,+n? fut'inlta' w.at flit..
;!rpv,G•r,n5 CJ?^ta;'i~d I;; Sec' n ~•4?7. • t1A'~4i9ri .^Ott~ city Ct~f.~lP.jH-I,rJ 88 rgpq>t~n~ rPgtllrwrrg~`..5,
`~it~t'.3tU,1- ,7(LU4`•gter ... .~~^"1_._.._.._.. _. r' l1 - - ----
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required).
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 lobbvina 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 lobbvinp on a pending application for a Development Agreement with the City or
application for change of zoning map designation or change 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 snot-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: ~.%~ 6~'~'-° /
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATUR A P
State of Florida, Co ~iararF~dede~sslo DD~~92
Swom to and subsc re ~m~_Marzs,2olt ~'
This day o 1x~s•NOS~xr D~mtar~.>c.~r.
X71 _ -~ / ~
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
0 Produced ID
Form of Identification
Personally known (Principal)
~~o I~R~/~ f~C~A.J
MY COMnIISSION N DD674292
State of Florida, Co ~~ iami~ Mares, zoI I
Swom and subscrib Fl. Notary Diuount A,:AC. Co.
This day of , 200_, '
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 Paid $ MCR # Date Paid
Lobbyist Registration Form received and verified by:
F:1CI,ER\~XLf.~aFQRNI~~LC?BBYIS'r FQRMS1Lobbyisd Registration Form 2i101.c6oc Revised 02/11/2009
I do solemnly swear that all~f-th~TOregoing faces are true and correct and that I have read or am familiar with the
provisions contained in S tion 2-482~{the Mia~fii Beach Cityfrode and all reporting requirements.
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City of Miami Beach, 1700 Convention Center Drive, Mia~~p8~'Florida 331~3~~.~fi
CITY CLERK Office ~1~ \' ~~t~t ~,'GityClerk@
Tel: 305.673:741 1 ,Fax: 305.673.7254
~EtY
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LOBBYIST NAME: o'S~~ 10 f'~ ~~N~D
iamibeachfl.gov
miamibeachfl.gov
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.
~o ~.~i n
Signatu e: Date:
F:ICLER\LOBBYIST1Lobbyist Registration Form 32708.doc