Anaide Govaert/Emanuele ViscusoU~~
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City of Miami Beach Office of the City Clerk
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, defeat or modification of
any ordinance, resolution, action or derision of arty commissioner, any action, decision, recmnmendation of the City Manager or any dty board or
committee; or any action, decision or recommendation of any aty 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 aty commission, or a city board or committee. The term
specficaly includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists° has specific exclusions. Ptease
refer to Ordinance 20043435. J
~1OV0.2~~' Prn0.td2,
NAME OF LOBBYIST: (Last) (First) (M.I)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Ztp Code)
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TELEPHONE NUMBER: FAX NUMBER: EMAIL:
.Please notify this office if your contact information changes: address, phone, ore-mail address.
1. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAUCLIENT:
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (fate) Code) 3 3 .r~i(
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TELEPHONE NUMBER: FAX NUMBER: (Ootionall t=i~tau • ~n~n~.,~n
out this section if principal is a
or Trust [Section
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 546 OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
n.SPECIFIC LOBBY ISSUE:
Ntiawu ~~ V+ s i for ~ Co-~~eh~toh ; `s ~.y~-w+r~,l To~r~ s w~ ~,~'w~s
Issue to be lobbied (Describe in detail): ~~.0~~-~~ _ ~piNQ, ~ ~2Q~'f'l. q° ~Oi^ -~`-~-
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(9) 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 - furtlter, 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
personnel' commencemertt 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) An Financial, Familial or Professional Relationshi
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N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (D13CLOSE VYHETHER HOURLY, FLAT
RATE OR OTNER):
A) LOBBYIST DISCLOSURE: (Required) w t,~ ~V~V~~ 5 _ 1 . _
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST CwOMPENSATION): AA ~~__ R~'~,Q ~ I- ~ L
(Required). IW ~~ pQMS~{•t.01n
The following information must be answered:
Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
_^ Yes m No: Are you lobbvina on a uresent or pending bid for goods, eauioment or services. or on a
preSerrt 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 ll~' No: Are you lobbvina on a pending application for a Development Agreement with the City or
application 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 definfion 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 specal 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.
LJ Yes ^ No• Are you repr+esertting snot-for-profit comoratton or entity without special compensation or
reimbursement .
SIGNATURE UNDER OATH:
,`,~ttt t t t irrrr~,' Signature of Lobbyist:
`~~~~ y ~;: ~~ ~'~nature of PrinapaUClient:
~~ ; VI ~ LOBBYIST IDENTIFICATION:
t~io =
tto~aut+r
~~ ~ ^ Produced ID
'~~ ~ ~ ~.` Form of Identification
~~~htttN~~~ Lil Personally known(Lobbyist)
VII. SIGNATURE AND STAAAP OF NOTARY:
State of Florida, County of Miami-Dade
Swom to and subscribed fore me
This j ~ ~ayipf ~ti , 2010
Signature f~Gblic Notary -State of Florida
Notarization of LobbvisYs signature
Annual Registration fee: [ `' ]Yes [ ] No Amount Paid
Lobbyist Registration Form received and verified by: _
F: \CLER\SALL\aFORMS\LOBBYIST FORMS\LObbvist Reaistrat
PRINCIPAL IDENTIFICATION:
^ Produced ID s * a
y °r
Form of Identifigtion a
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Personally known (Principaq o •'
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om~
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State of Florida, County of Miami-Dade ~ ` N m
Swom and subscribed before me ~ ~ z z
This IS day of 1 rJ N i= , 2010
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Signature of P blic Notary -State of Florida 3_~
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Notarization of Principal's signature
tERK'S STAFF ONLY
~ ° ~-' Date Pafd
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d Revised OS/ /2010
Signature of Lobbyist
I do solemnly swear that all of the foregoing fads are true and correct and that ave read or am familiar with the
provisions contained in Section 282 of the Miami Beach City~Code and all reporting requirements.
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City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miomibeachfl.gov
CITY CLERK Office CityClerk@miamibeachfl.gov
Tel: 305.673.7411 ,Fax: 305.673.7254
Acknowledgement of fines/suspension from lobbying for failure to
comply with City of Miami Beach lobbying Laws
LOBBYIST NAME: __ ~Yt0.~C~ei ~O V'Q.PX'~"
I understand that no later than October 1st of each year, lobbyists subject to lobbyist
registration requirements shall submit to the city clerk a signed statement under oath
listing all lobbying expenditures, as well as compensation received, for the preceding
calendar year with regard to the specific. issue on which the lobbyist has been engaged
to lobby. A statement shall be filed even if there have been no expenditures or
compensation during the reporting period. The statement shall list, in detail, each
expenditure by category, including food and beverage, entertainment, research,
communication, media advertising, publications, travel, lodging and special events.
Failure to timely file the expenditure and fee disclosure report will result
in a fine of $50.00 per day. Any lobbyist who fails to file the required
expenditure report by December 1, shall automatically be suspended
from lobbying until all fines are paid, unless the fine has been appealed
to the Miami-Dade County Commission on Ethics and Public Trust. In the
event a lobbyist fails to either file the report and/or pay the assessed fines, the Clerk shall
notify the Miami Dade County Commission on Ethics and Public Trust.
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.
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Signature: pa ;