Loading...
Jorge Dorta-Duque/Charles Group, Inc.;r. - /, ~ . ~ a ~ ~~3v~c13 32 . _ C~ llns City of Miami Beach Office of the City Clerk 4700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM ` Lobbyist mearis 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 cdmmittee;,or any action, decision or recommendation of any city personnel during the time period of the entire decision-making process on such ' action, decision orrecommendation that foreseeably will be heard or reviewed by the city commission, or a city board or committee. The term specifically includes the principal' as welLas any employee engaged in lobbying adtivities. The term "Lobbyists"-has specific exclusions. Please refer to Ordinance 2004-3435. ~ NAME OF LOBBYIST: (Last) (First) (M.I) ~, ~o,e-~ ~ ~©2-~Q -~ vc1 v ~ ~~ t ~ ~ F~ ~1 ~~4~ Sw ~ `l ~ 7 ~ Id~tc ~' ~L 33 r ~ ' .BUSINESS' NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) ' l.~a~J~~et-~'4a~ 3os" (~3`~~'l ~pIZ~aDv~<loC_~ TELEPHONE NUMBER: FAX NUMBER: EMAIL: L LOBBYIST RETAINED BY: _ ~ C 1-~ ~S 2z ~s ~,12~ c~_P L[,~, ~J , co ~ ~ ~ I ss , P~~ s t ~ ~ r NAME OF PRINCIPAUCLIENT: SINE S NAME AND ADDRESS (Number and Street) (City) (State) ` (Zip Code 30 ~ 'z.,zl 4d ~ ~ ~~., TELEPFfONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) ~ut'this section if principal is'a Corporation, Partnership or Trust [Section 2-482 • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP 1NTERESTiN SUCH CORPORATION, PARTNERSHIP OR TRUST: u:SPECIFIC LOBBY ISSUE: ~ 3 3 ~ - 43:~ Z ~ ~ ~ ~>.v s ~,,~ ~ ~~,~~ ~f` GQ ~eeGe ~'~ ~ R~y~S T ~o ~ ~~ !~Z l~ (e.4.2 ©~ ~ ~l~s ~r2L6 `t k C sS Issue to be Iobbled (Describe m detail): . ~ Fat D~2~7r; ~Pa2-i~-ce.~t~s [t.c: ~t~R~C~~ ~sPP~F~2 duo (~Lac~ Pa:rLkl~6t ul. CITY, AGENCIES/INDIVIDUALS 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 ah 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 said City personnels' 'commencement of service with the City to the present date, stating the general nature. of the-•subject contractual relation. A FuII:Name of Individual Title B) Any Financial, .Familial or Professional Relationship ~ o~' bof~S7hc~-7 ~~i ~o~~ 6~ ~~a ~~ 1 IV. DISCLOSURE OF TERMS AND AMOUNTS. OF LOBBYIST COMPENSATION {DISCLOSE WHETHER HOURLY, FLAT '. RATE DR OTHER): A) LOBBYIST DISCLOSURE:...(Required) ~ ~S~ c~ Jam[ ~,~Q L~ B) PRINCIPAL'S DISCLOSURE, (OF l_OBB . ,. YIS~CO~P~~N$AT~~I): ~V2L~ (Required)._ " The following information. must be answered: T) Pursuant to'Miami'$each City Code Section 2-488 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 Cohtributions By Lobbyists On .Real Estate Development Issues": , ' ^ Yes' ~ No: Are you lobbying on a pending application. fora Development Agreement with the City or application for change of zoning map designation or change to the City's future Land Use Map? 3) ~"Pursuaht 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 arepresentative" 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 sectioh but, shall not be required to pay any registration fees. ^ Yes ~No: Are you representing. snot-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: " ON OCTOBER. 1sT OF EACH YEAR -EACH LOBBYIST SHALL S TO THE CITY CLERK. A SIGNED STATEMENT UNDER .OATH. LISTING LOBBYING EXPEN UR AS WELL AS COMPENSATION ;" .provisions contained ih Se 'on.2 Signature of-Lobbyist: Signature of Principal/Client: VI. `LOBBYIST IDENTIFICA' 'roduced ID do solemnly swear that all o ~ ' `>>~~-11111111b/I/ ., \~~~~ p,, HATE/F~~i,~~~~ is , o~ . A-., #DO~~.~..~~ 5igfiatur of Lobbyis~ ~egoing facts are true a correct and that I have read or am familiar with the of the a i Beach City Code and all reporting .requirements. Form of identification,. ~ sonaliy known (Lobbyist) NATURE AND STAMP OF NOTARY: da; County of ..Miami-Dade I subscribed before a Jp _day of '~~, 20 ~. Signature f Public Notary - Notarization of Lobbyist's sig PRINCIPAL IDENTIFICATION: ~1?roduced ID -Form of Identification Personally known (Principal) State of Florida, County of Miami-Dade Sworn an subscri ed befor me /p This day of ~„~ , .2009', Notarization of Principal's !>. `, ' >- ~ - ,/ ,,~• .. - _ ..fib"' _ ' City of Miami .Beath, 1'700 Convention Center Drive, Miami Beach, Florida 33139, www,miami6eachfi.gov w` CITY CLERK Office .. " ~ CityCderkCmiamibeachfl.gov ' Tel: 305.673.741 1 ,Fax: 305.673.7254 ,.• ^ `. GOBBYIST,NAME: ~(ZG c_c~ ~O~-?"~--~~~ y `Z-, _ ~ ° : I u~riderstand that no later than October lest of each year, i must #ile the following forms; pursuant to Section 2-485 of the Miami $each ,City Code, with the City4 Clerk's Office for all active-lobbying issues. . l) .Lobbyist Expenditure Form. . ~ ~ 2) Disclosure form ~ , . . , .. ; Failure to file these forms on a timely basis wi11 result in my name being transmitted to_ the Miami-Dade County Commission on .Ethics and for code.violation evaluation. 1n addition; .once ari .issue 1 have registered to lobby on "has been resolved, 1 am .required .. . . ' . ~ : ~ `tb im is ely notify the.-.City Clerk's Office.of lobbyist withdraws! in writing:. - ' Signat re; ~ ;Date: F:ICLERILOBBYtSTILobbyist.Registration Form 327DS,doc