Rafael E. Andrade - Beach Towing Services
m MIAMIBEAC~
City of Miami Beach Office of the City Cferk
1700 Convention Center Drive, Miami Beach, FL 33139
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LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a prinripal who seeks to encourage the passage, defeat or modification of
any ordinance, resolution, action or derision of any commissioner; any action, decision, recommendation of the City Manager or any rity board or
committee; or any action, derision or recommendation of any dty personnel during the time period of the entire derision-making process on such
action, decision or recommendation that foreseeably will be heard or reviewed by the rity commission, or a city board or committee. The term
sperificelly indudes the prinripal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please
refer to Ordinance 20043435.
NAME OF LOBBYIST: (Last) (First) (M.I)
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TELEPHONE NUMBER: FAX NUMBER: EMAIL:
P/ease notify this office ~ your contact information. changes: address, phone, ore-mail address.
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT:
BUeSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
EMAIL:
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: ~/~~~~ /C4~~T/`f-
• .IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST: /~1iCI7//¢'FL F~-'S?6I
u.SPECIFIG LOBBY~ISSUE
Issue to be I~bied (Describe in detail): ~'
e~,,
ul. CITV AGENCIES/INDI1/IDUALS 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 an
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
personnel' commencement 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 Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A LOBBYIST DISCLOSURE: (Required)
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): /~ j
(Required). d/ / }KsuT f MP~.•s~"7dN ~CAAr.~~'terY~G~o~ ,f r SJnK" ~e~e /7A~ ~ P!~,
The following information must be answered: j
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^ Yes o: Are you lobbving on a present or pendina bid for goods. eauipment or services. or on a
present or pendina award for goods. eauipment 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 pendinq,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 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
,s~ectio~n but, shall not be required to pay any registration fees.
^ Yes LJNo: 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:
of Florida, County of Miami-Dade
i to~d~ scribe a me
'~/ ~9ay of , 2010
State of Florida, County of Miami-Dade
Sworna~~s~scrib d b re me
This ~~~a71 of _~~ , 2010
~~r~w//.
I do solemnly swear that all of the foregoing facts ar rue and correct and that I have read or am familiar with the
provisions contained in Section 2-482 oiami Q~~ity Code and all reporting requirements.
r
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office .
Tel: 305.673.7411 ,Fax: 305.673.7254
CityClerk@miamibeachfl.gov
LOBBYIST NAME: ~A7T~~ ~• ~ ~~ C
I understand that no later than February 28th of each year, I must file the following
form, 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 and Compensation 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, 1 am required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
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Signature: ate: