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Elinor E. Perla - Latin EPR vci4 , 1 (11 MIAMJFEACH t t . ---....--. 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. Per la C-1( nor NAME OF LOBBYIST (Last) (First) L a ` v.. &' P/? 7y, e. AST 1�1lerae4 A /o/ 1`O ae et L 33 /3? BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) - Code) 3 (;),,,C - ,.s'33 - o 9,,s / `-3 f S3� C��� e / e e / a 09 ae TELEPHONE NUMBER FAX NUMBER. EMAIL. Please notify this office if your contact information changes: address, phone, or e address. I. LOBBYIST iETAINE BY: 1 6-Na NAME OF P INCIPAUCLIE T a �� - SS lie en c� / -L. 3 3 BUSINESS NAME 9pID P DDRESS (Number and Street) (City) (State) (Zip OS ti(3S - Oq,r/ Zoff' - s71 . ( , -- (P/q e l / C - (e pe L a oe - �' . TELEPH NUMBER FAX NUMBER (Optional) EMAIL: (Optional) - _ r Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] c`) i • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY. tom' //e 7 c't_- -:: N - 3 ,. ) • IDENTIFY ALL PERSONS HOLDING, DIRECT O R IN IRECTLY,.,4 5% OR RE OWNERSHI INTEREST Il l.BUCE ORP ATION, PARTNERSHIP OR TRUST. e--#) l7 / C r�--f Cat- h _ PP ( - JJJ���" � ( r �/ II.SPECIFIC L BB ISSUE: ' --J Pub //e / i 0 /7 _S i' / /annj 3 oe any Coo rta /4-eihorj Issue to be lobbied (Describe in detail). III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2482(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 nd / Contractual Relationship (Explain) YES NO title of person to be lobbied t la VOA ft ( f2 / ? e o tze /�ic�i(�� , l = ci)ce eA' € ,bike � c f 01 (' ee We re f'o�rs re ed �° } x 7 Caro -- (d - k, eJ , 71 /' G 1 r� J ? C &7 /een c t alc C- e , sciS fe c// 9f ,x Pursuant to City Code Section 2- 482ver registrant shall be r Y g) Every eg required to state the extent of any business, financial, familial or professional 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 gistration form filed. Sec 2- 482(g) Any Financial, Familial or Professional Relationship c c9 - z/ (a) C0k)fc¢' �3C1�/� Pry1 /fern/ers' C// e rh 0tuaS ; • ( eAmah he - ra17 L `//5 V a � e 7/ert2 ce7 Heh ,� /e s . (� S v & -9<, IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): L Y I S T SCL 0 Alerr u 'o/ O 0/. 67,6,x_ , 4i e. ./hefl-u 0,' /l a 7 iel/ C 00,,C?6,,1 Mood, B) PRINCIPAL' • DISCLOSURf (OF LO YIST COMP . I t (Required). w'a.,r GC te. a.e Lent- SATION) �a' . avid ��U //am U1�oU1 �v �c;� r� 'v� a mo , re ' h I L2 e wCeuVetA The following in ormation mus be answered: ■ 1) Pursuant to Miami Beach City Code Section 2 - 488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues ": IY 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 p 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, shall register with the clerk as required by this section but, shall not be required to pay any registration fees. ❑ Yes p 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 FILE EV+1 THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. / i� Signature of Lobbyist I do solemnly swear that all of the foregoing facts are true and correct and that 1 have read or am familiar with the provisions contained in Section 2 -482 of the Miami e h ity Co dall reporting requirements. Signature of Lobbyist: Signature of Principal /Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: © Produced ID " FL . t0 / /,— 1 m~ff l o �p_ Produced ID�� 2 65' 5V - Ella _ d = Form of ldenti cation ation o 0.d o t ? Form of Identification a , `, ,, -,,, ❑ Personally known (Lobbyist) '';',"P„,; � ❑ Personally known (P o A...' .N, . ISABEL SATCHELL n 0 ' � � m �, .. MY COMMISSION N DD 879891 m VII. SIGNATURE AND STAMP OF NOTARY: 3 3 v . EXPIRES: April 13,2013 (7 ; 3 • Er m • ' Bonded Thru Notary Public Underwriters State of Flori la, County of Miami -Dade a a a State of Florida, County "'" S • p to an•I•ubscribed before me y y ° Swom nd subscribe bef re me T s (. of w ^ e__ , 2011 °o w i. m This d t day of , 2011 pq Sign - ure of ' ublic' ya'' VState of Florida o o Signature Public Not • —5 ate of Florida Nota zatio ! of Lobbyist's si ture w °' Notarization of Principal's signature f s Pn1 ! made TO BE COMPLETED BY CITY CLERK'S STAFF ONLY /_ Annual Registration fee: [ ] Yes [ ] o Amount Paid $ >I MGR # D • Date Paid (t/ 2 t / / Lobbyist Registration Form received and verified by: / X ��,(� F : \CLER \SALL \ri ' "S \LOBBYIST FOr t. obbyist ival Registration Form.doc , �Q % ' ��1i f ✓ / �� Z4 Revised 1/1 /2011 MIAMIBEACH 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: /e r/a__ 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. e l 20(( r Signature: Date: