Elaine Rinaldi - Orchestra Miami m MIAMI
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 mined, 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 oom nlssioner, any action, decision, reaonmrerdabon of the City Manager or any city board or
comnttee: or any action, decision or recommendation of any city personnel during the time period of the entire der - 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 prinndpal as well as any employee engaged in lobbying activities. The term °Lobbyists° has specific exclusions. Please •
refer to Ordinance 2004 -3435.
* Tina la1 ➢ E7ain:
NAME OF LOBBYIST: (Last) (First) (M.1)
C� rcit s6t, M taw∎ O 21 SW Slf 7"er M tu141, 33
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) ) (Zip Code)
. OK') ?'Z5 eri;inldi t � O r d A i S } Wltarnl •0
TELEPHONE NUMBS FAX NUMBER: EMAIL: .J
Please notify this office if your contact information changes: address, phone, or e-mail address.
I. LOBBYIST RETAINED BY: A
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NAME OF PRINCIPAUCUENT:
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BUSINESS NAME AND ADDRESS (Number and Street) (City) / (State) (Zip Code)
(360 21 - 9 - 10A www•Ordetes rhtawn •ovr)
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:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
i LOBBY ISSUE:;
M (sates Gra.IA- Et. Co 1 tV Otue -ko rAenl For 2011
Issue to be lobbied (Describe in detail):
III. 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 wlh the City to the present date, stating the general nature of the subject
contractual relation.
A) Fuil Name of Individual/Title B) Any 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) N v COser pen Sah b Y\
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ✓LSo kfoli
The following information must be answered:
1) Pursuant to Miami Beath City Code Section 2 Entitled Prohibited Campaign Contributions By Lobbyists
On Procurement Issues ":
13 Yes 4o: Are you lobbying on a present or pending bid for goods. eauioment or services. or on a
present or pending award for goods. enulpment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled °Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
p Yes g No: Are you lobbying on a pending application for a Development Agreement with the City or
application for change of zoning map designation or chance to the City's Future Land Use
MeD?
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 derk as required by this
section but, shall not be required to pay any registration fees.
Yes ❑ No: Are you 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 EXPENDITURE COMPENSATION D :. NG THE REPORTING
PERIOD.
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct : • d that I have read or am familiar with the
provisions contained in Section 2 of, Miami Bea. code a • • = reporting requirements.
Signature of Lobbyist
Signature of PnndpallClient: M fir
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID
C 1 ab311(0 11 Produced ID � 24
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Form of Identification F of Identification
❑ Personally nown Lob
Y (Lobbyist) ❑ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Flori= -, County of Miami-Dade State of Florida, County of Miami -Dade
Swo to a + • : me Swo ' and subscri • :- • • • re me
This _ day o f -- This .J key of I.' i ru.,/ 010
I ,�5�: •,
ANA C.J1MENEZ '
//41 ,t•� *- MY COMMISSIONSDD917755 i ! l i fdi11 / . ,
Signatu -u. " No ' .' ' '.`;u °� t 1 Sig ? -'i re • Pu' Notary ; ".'• Florida ANAC. JIMENEZ
Note . J ,,, f:,.:::; a, s r,.. Notariza •n of , ci . 1 _ MY COMMISSION #DD917755
EXPIRES: September 12, 2013 ,
TO BE COMPLETED BY CI RK'8 STAFF ONLY • i '�fi Banded Tin Notary Public Undervatters
Annual Registration fee: [ j Yes [ j No Amount Paid $ MCR t I". , a
Lobbyist Registration Form received and verified by: / 2?
F: \CLER \$ALL \aFORMS \LOBBYIST FORMS \Lobbyist Registration Form 2010.doc Revised 05/0 /201
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M A AMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254 •
LOBBYIST NAME: Om ge_. I kS
I understand that no later than February 28th of each yer,. 1 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 1 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: Dote: