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Rafael E. Andrade - Beach Towing Services of Miami, Inc. • ►� a7 -!7 a04 You) i aeS•o- 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 decision of any commissioner; any action, decision, recommendation of the City 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 includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004 -3435. Andrade Rafael E. NAME OF LOBBYIST: (Last) (First) (M.I) 1674 Meridian Avenue, Miami Beach, F1 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 216 -2028 (305) 674 -8965 ram1970@bellsouth.net TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes: address, phone, or e-mail address. I. LOBBYIST RETAINED BY: Beach Towing Services of Miami, Inc. NAME OF PRINCIPAUCLIENT: Beach Towing Services of Miami, Inc. 1349 Dade Boulevard, Miami Beach, F1 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 534 -2128 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Michael Fes President • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Michael Festa ■ u.SPECIFIC LOBBY ISSUE: Representation concerning land use at 1747 -1759 Bay Rd., Miami Beach, F1 33139, land use matters in the I -1 Light Industrial District and towing and storage uses throughout Miami Beach. Issue to be lobbied (Describe in detail): 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 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) Any Financial, Familial or Professional Relationship L'ity of Miami Beach Mayor and Commissioners None City of Miami Beach City Manager and Staff None City of Miami Beach City Attorney and Staff None City of Miami Beach Planning and Zoning None Department and Staff R11 L1t.y scarab and members mane All City Committees and Members None All City Staff • . . None + J0 S.} A113 8C:1 Wd 9- NVr 110Z 0 AI -038 • IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) No compenation B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). No compensation 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 vou 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 Contributions By Lobbyists On Real Estate Development Issues ": ❑ Yes © No: Are you lobbying 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 a not - 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 E1 No: Are vou representing a not - for - profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON FEBRUARY 28th OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH. LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of L •b ' I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 o • - Mi- , -ach City Code and all reporting requirements. Signature of Lobbyist: � ; // ' • Signature of Principal /Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: % ° ❑ Produced ID Produced ID Ft e '�. •, Form of Identification Form o 1 •.� • "r � IBRAHIM GRCIC nU • i x o ,+ ( ‘ 1 ' Notary Public - State of Florida v g• § Personally known (Lobbyist) ❑ Personally known (Print -`: .1 3 , s� My Comm. Expires Dec 3, 2012 Commission # OD 842671 R VII. SIGNATURE AND STAMP OF NOTARY: 1 ••°.; �' Bonded Through National Notary Assn. i j I (n O d State of Florida, County of Miami -Dade State of Florida, County of Miami -Dade y S. Sworn to pnd subscrib efor aAA me Sworn subscribed before me - • This day of JPc4 , 2010 This v�da m _ Signature of Publ, /otary — State of Florida Signature of Public Notary — State o orida Notarization of obbvist's signature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ] Yes [ 1 No Amount Paid $ '654 MCR # _ j80LAY/U7 Date Paid 6 // Lobbyist Registration Form received and verified by:. F: \CLER \$ALL \aFORMS \LOBBYIST FORMS \Lobbyist Registration For 2010.doc Revised 05/05/2010 to ; it r % ; City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityClerk @miamibeachfl.gov Tel: 305.673.741 1 , Fax: 305.673.7254 LOBBYIST NAME: Rafael E. Andrade 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, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. Signature: Date: • l c 3. . nN ® S® . O - 3; " . . 0 s . 1 N '1 c. £ 'N • ;� . a. _ � 4 . °` ` ` ? III i r • ' / • . ! � , . r q. X. • i flea ^p+ 41 • . g N 0 ` MP