Julio C. Diaz, II - Erik Brakken• L i /~ 1v ~ lJA 9,C
~ MIAMIBEACH ~'~}
City of Miami Beach Office of the City Clerk . ~~
1700 Convention Center Drive, Miami Beach, FL 3~~ ~ $ PFD 4; 45 ~,
LOBBYIST REGISTRATION FORM ~ (~ }' (; a._ ~ h t „~ ~ ~ ~ ~;- ~ ~ L- ~ i
Lobbyist means all persoris employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat or modfication of
any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the Ciry Manager or any city board or:
committee; or any action, decision or recommendation of any city 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 city commission, or a city board or committee. The term.
specifically inGudes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has speclflc exclusions. Please;
refer to Ordinance 2004.3435. '
.G z. ~ .~~I,~ ~
NAME OF LOBBYIST: (Last] (First) (M.I)
SE~u [~~w~ 3a~ 333 ~15~ 5t ~,u~,,'~~~ I"~ 3~1~
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code) ,
~3~s) ~3S_~7rtct ~yS -67~ `~(S-~~ ~G~~GiZ~3SelU 3r~~).~Y'c, ~~'I
T LEP ONE NUMBER: ~ FAX NUMBER: MAIL:
I. LOBBY]]I~~ST RETAINED BY:
L 1"i~c U~"G ~~P/t ~'
NAME OF PRINCIPAUCLIENT:
sr-~~ 3a~~ ~ 33 ~l ~ S-~ v
BUSINE S NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) `, ;
f~os~ 67~ - Jo7/
T~Ei.EP ONE NUMBER: FAX NUMBER: (Optionaq EMAIL: (Optional) ,
gut this section if principal is a Corporation, Partnership or Trust [Section 2.482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5°k OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
n.SPECIFIC LOBBY ISSUE:
~ ~ '
L~ V)re, ~~ue (5r~/h~ti<~ ~• G,,/ ~h Pcld S,~k Lea,
Issue to lobbied ( ascribe in detail):
lil. 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 an,
appearance of an impropriety with any City personnel sought to be lobbied -further, pursuant to Clty 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) Any Financial, Familial or Professional Relationship
Jer•~ L~'~yh L rvrn~'ssi~^fi'
veep L`'c fro. Ca fs i:n I
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M/GhOPr~ Gpti Oe LOHI'h ~ f,ac•V'
L'~ aA 'ate
A /
GrrGrc, - aVY G si-
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 lobbyinp on a present or pending bid for goods equipment or services or on a
present or pendina 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 lobbvina on a pending application for a Development Agreement with the Citv 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:
of
I do solemnly swear that all of the foregoin`g~acts are true and correct and that I have read or am familiar with the
provisions contained in Section 2-482 of the Miami Beach City Code and all reporting requirements.
Signature of Lobbyist:
Signature of PrjRF{S"al/Client: ~-~--
VI. LOB(/B/YIST IDENTIFICATIO-N-:
.Produced Ib f"'LoiL\ ~~ 1~. • L .
Form of Identification
^ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
PRINCIPAL IDENTIFICATION:
~ Produced ID L~ 2t DA , L.
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miami-Dade
+ 'his ~!'SC1~5L~tt fore me
~ wl~ , 2010
Notary u
Commissio
State of Florida
o riza ion o o v s s signature
State of Florida, County of Miami-Dade
Sworn an~ subscribed
This day of ~ K 0 0 NIGEL A, OeSAlEB ,
,~ Notary PuOtic, State of FlaiQa
CommissionN 00958aT9
Signature of P li o ry -Sate 1~PI81=iexpirey Mar. 7, 2p14
Notarization of Princip
TO BE COMPLETED BY CI LERK'S
Annual Registration fee: [ ]Yes [ ] No Amount Paid $
Lobbyist Registration Form received and verified by:
F;\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form 2010.doc
STAFF ONLY
Paid
Revised 05/0/2010 ~
m MIAMIBEACH
City of Miami Beoch, 1700 Convention Center Drive, Miami Beach, Florida 33139, v,~ww.miamibeachfl.gov
CITY C1ERK Office
Tel: 305.673.7411 ,Fax: 305.673.7254
CityClerk@m iamibeachfl.gov
Acknowledgement of fines/suspension from lobbying for failure to
comply with City of Miami Beach lobbying Laws
LOBBYIST NAME: _ vl~u ~/~4z ~~
/~-~
I understand that no later thin pct t of etch 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 resul#
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.
gnature:
6,
~~~
Date: