Alicia M. Rainbolt - Cori Rice �¢
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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 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.
NAME OF LOBBYIST: (Last) (First) (M I)
Y1hO'1t 11toa.
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
ZA5 WANSK, NIA t 0 n
TELEPHONE NUMBER: FAX NUMBER. EMAIL:
Please notify this office if your contact information changes: address, phone, or e-mail address.
LOBBYIST RETAINED BY:
NAME OF PRINCIPAL /CLIENT.
Loft K∎ L
BUSINESS NAME AND,AD RES (Number an d Street (City) (State) (Zip Code)
111 l r1 1 5 Ai mc.- trtAel 33O coal (nt. 01'9 FL- '33019
TELEPHONE NUMBER. FAX NUMBER: (Optio al) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust ection 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.
U.SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2- 482(a)(4) include the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's
commencement of service with the city to the present date, stating the general nature of the subject contractual relationship.
Sec 2- 482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES NO
title of person to be lobbied
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Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extent of any busing s,- llipar ' ,` r mi 1 I I i essional
relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner or city personnel who is
sought to be lobbied as identified on the lobbyist registration form filed. £ �lnr 1 IUZ
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Sec 2- 482(g) Any Financial, Familial or Professional Relationship GG G G PII I U/.
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE: (Required) r ciLtkiti !' k C0 v
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). r aita,invinaLk C VMS/A
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 ":
Ltd Yes ❑ No: Are you 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 M 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 City'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, hall register with the clerk 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 EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
CiLt
Signature of Lobbyist
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 of the Miami Beach City Co e and_alll requirements.
Signature of Lobbyist. O� /uv K/V ,L4 L
Signature of Principal /Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
/Produced ID h (,e,11 ❑ Produced ID
Form of Identification Form of Identification
LEI Personally known (Lobbyist) ❑ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami -Dade , Q` Y*if..- R.OBERTO A GONZALEZS to of Florida, County of Miami -Dade
Sworn,t„o and subscribed before me �`
� P .>tY COMMISSION # DD806535 orn and subscribed before me
5
This (5} y . day of Ma , 2011 ..`k.7: ` , E xPI R .ES Jul 16 2012 T is day of , 2011
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or—
(407) 398-015. FlondallotarySernce.com
Signat e of Pu• Not — State of Florida Signature of Public Notary — State of Florida
Notariz- • L Lobbyist's si ; ature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONL
Annual Registration fee: [ ] Yes [ ] No Amount Paid $ 4. MCR # 72WAFT& Date Paid ' V
Lobbyist Registration Form received and verified by:
F: \CEEB \BALL \aFORNiS \L068YI5T FORMS \Lobbyist Annual Registration Form.dor- f f 011 Fii Revised 1/1 /2011
IV. DISCLOSURE OF TERMS AND AMOU S OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT R
OTHER): 9 t V V
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A) LOBBYIST DISCLOSURE. (Required) 1 011 ` 2
Nit C ' 15 0 SP6 . �� z PM 12; 32
y r,
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST C.MP S TION): - L t • ,S
li
(Required). A / � 4, St"a01 OF rICE
The following information must be answer • d:
1) Pursuant to Miami Beach City Code section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement
IV/ Issues':
LVd Yes El No: Are you lobbying on a pre • ent or pending bid for goods, equipment or services, or on a present or pending
award for goods, equipme t or service?
2) Pursuant to Miami Beach City Code '-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
Development "'
el lopment Issues
❑ Yes L( No: Are you lobbying on a pe ding application for a Development Agreement with the City or application for
change of zoning map des gnation or change to the City'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 :ppears as a representative of a not - for - profit corporation or entity without special
compensation or reimbursement fo the appearance, whether direct, or indirect, to express support of or opposition to any
item, hall register with the clerk as equired by this section but, shall not:be required to pay any registration fees.
❑ Yes No: Are you representing a no -for- profit corporation or entity without special compensation or reimbursement. .
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th OF EACH YEAR, EA H LOBBYIST SHALL SUBMITTO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITUR S, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A - TATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTI G PERIOD _
Signature of Lobbyist
I do solemnly swear that all of the foregoing 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 Cope ancLall reporting requirements.
Signature of Lobbyist: attU 1(
Signature of •Principal /Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
/Produced ID UL' ) Produced ID •
Form of identific. Lion Form of Identification
/Personally known (Lobbyist) Personally kno "" .palpOBERTO A GONZALEZ
VII. SIGNATURE AND STAMP OF NOTARY: �` MY COMMISSION # 00806531
EXPsir July 16,
State of Florida, County 2012
of Miami-Dade <.^:.' s ,1 FboridallotaPJ
Y e YP'
U •. ROBERTO A. GONZALEZg� =te of Florida, C 7 - e�M1lbmi -D�t
{
Sworn .Lo and subscribed before me , 41'
� - 7 _ MY COMMISSION # DD80653� OM and subscribed before me
This ( day of 1VlRy , 2011 ' • - • EXPIRES JuIy 16. 2012 T is ( da of 2011
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✓� (• . )398 - 0153 FloridaNOlery5erviu.com
Signet .• Not. -� - State of Florid. Signature of( LITRLIZEW tate of Florida
( NotarizLobbyist's si ature Notarization c : - s signature
0 BE COMPLETED BY CITY CLERK'S STAFF ONL !
Annual Registration fee: [ ) Yes [ 7 No • ount Paid $ � "- -MCR# s _ ' i (% I
�, �. � D Paid
Lobbyist Registration Form received and veri ed by:
F: \CLER \$ALL \aFORMS \LOBBYIST FORMS \Lobo ist Annual Registration Form.tloc Revised 1/1 /2011
tr / V \ ANAIBEACH
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: Ah(At ' KtitkfiVO I t
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.
Mate( Jikolati, .rAtk,\A - Ro I
Signature: Dat :