Don C. DeLoach - Dyntek f L l , t1� 1
MI AMIBEACH r.3
City of Miami Beach Office of the City Clerk r
1700 Convention Center Drive, Miami Beach, FL 33139 p = t
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LOBBYIST REGISTRATION FORM tp
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the p agerdefeatar
modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommenon irthe t
Manager or any city board or committee; or any action, decision or recommendation of any city personnel during the te pepdd of
entire decision - making process on such action, decision or recommendation that foreseeably will be heard or reviewed b" he city
commission, or a city board or committee. The term specifically includes the principal as well as any employee engaged i rbbying
activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. r'"'
teLOCLt _(n 10 to C
NAME OF LOBBYIST: (Last) (First) (MA)
One Ei t��t�t.5u. L -(; n `{ 13 N e-c -� c»n S t. -. cit1ck-�,.ct Ss e e., VI- 32-301
BUSINESS NA AND DDRESS (N4nber and Street) (City) (State) (Zip Code)
sr)- 'it 2- O3oc.3 5SS)- ` -o3`; ca ( - ),n ck e l tOacin < eWA.A.
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact Information changes: address, phone, or e-mail address.
I. LOBBYIST RETAINED BY: ++
NAME O RINCIPAUCLIENT:
C (90 LJe d.tne S ee, �Ae. enoc) 1. c L.O.Cd rcaScee c L 2 30 S
BUSINESS NAME AND ADDRESS (Numbe a Street) (Ci (State) (Zip Code)
RSU -a ‘ - `1oo 2 , -at,° - '1 n
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: .
'Ron b=e, - t 5 tt0. C'. b 0 f- PAest pe NT
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• IDENTIFY ALL PERSON HOLDING, IRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: Li c, Yd I. . III; 1 \ t r" 1 1 1 `1
II.SPECIFIC LOBBY ISSUE: 1 l
\ I i r�,Ati, fe gtr\ 1 - D( . . O44... ,Sex \) ex r u Clocl e c UAeQ ,
Issue to be lobbied (Describe in detail):
III CITY AGENCIES /INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(aX4) 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 : eneral nature of the subject contractual relationship.
Sec 2-482(aX4) Full Name of Individual and Contractual Relationship (Explain) YES NO
title of person to be lobbie • x
-
Pursuant to City Code Section 2- 482(g) Every registrant shall be 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 registration form filed. j�f�
Sec 2- 482(g) Any Financial, Familial or Professional Relationship \ \`3 ✓` �
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE: (Required) Q. 1, r�0b
N�c7+n��.t� �.� K pt
B' .-e-- O $ � a
( Requlrea). M t7 ,�
The following information must be answered:
1) Pursuaach City Section 2-4Ped s By Lobbyists On Pr cur `e nt
Issues ": "ti
r 'a:
❑ Yes ,1(J No : Are to Miami you lobb on Code a present or pending 88 bid Entitled fo goads equipment Campaign or serv Contribution ices, or on a presenter nq ,I"
award for goods, equipment or service? ' p
2) Pursuant to Miami Beach City Code 2 -490 Entitled "Prohibited Campaign Contributions By Lobbyists On ReaF'Estatl
Development Issues ":
❑ Yes :'4 No Are ou iobb 'n • on a • - ndin • a • • lication fo a Developmen Agreement with the City or apblic7fibn f ''
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.
x p Yes o: 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 COMPENSATIO ECEIVED, I THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHA E FILED E N IF THERE AVE EN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
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 B- -ch ity Code an• = re• oiling r :me /s .
Signature of Lobbyist: ■� _ i„ --
Vi. LOBBYIST IDENTIFICATION: ailliallialliiiillit
❑ Produced ID \ \\ / / / /i 0 Produced ID § \ \ \ \ \`ENFIPR/01 / ii i
Form of Identifi ..,.• + F o rm of Id i
• o mmiSS , 9 � y " ,-- fiSSip . <%, i
1*. .° •.# «ember 2 4' • • _\ 4124, 2 pEfo � •. Personally known ( Lobbyist) � % �z Z , t Personally known (Prina'gplJ '� m ; _ 6 a
� 6 . . • _ f4:5
= El f4 : G • e.... `o:
VII. SIGNATURE AND STAMP OF , Wf °DT : > .. #DD * � ZE
* , 4. 974551 ; Q
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State of Florida, County of Miami -Dade , V •:; te; s S tate of Florida, County of Mi i al..• , Q `
This day Sworn tq nd subs r b -' before me 2 01 i r fC STATE c, �� ` > `` Swam a subscri • before 1 L IC TATS C` �
Y !i'itHt . ' This / a it , 20 filmill\
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Si. lure of Public Nota — State of Florida Signature of Public Notary - State of Florida
Nor. rization of Lobbyist's signature / Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S ST_ F ONLY
Annual Registration fee: [ ] Yes [ ] No Amount Paid $ s Y,5 0 - - MCR # /1111 V D Paid t/
Lobbyist Registration Form received and verified by: ` hh
F:\CLER \$ALL \aFORMS \LOBBYIST FORMS 1Lobbyist Annual Registration Form.doc c ► Revised 1/11/2011
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: �D A- let-CaCCA.
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.
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Signature: Date:
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