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Tim Riera-Gomez - Joanne Diorio �1 I s; n I B E A = City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 AM EN�E D LOBBYIST REGISTRATION FORM (Chang _ b� Comi�Qn� y�Q � 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. i NAME OF LOBBYIST: (Last) First) (M.1) 23S 6 -�10_ni r b s BUSINESS NAME AND ADDRESS (Number and Street) (City) (Stat ) (Zip Code) -� 305- V1-a/- 1:t(Z 4D rnQLIMe2 3@ QMO l• foal TELEPHONE NUMBER: FAX NUMBER: i EMAIL: Please notify,thIs;gffice:if your'contact information'changes:atldress,,phone, of a-mail address. I. 28YIST RETAI BY. `e ro � M"a � Loco l So)Jt Dkls�.T,)c. C F 1A 11-cs N OF RI IP CLIENT: 30. 1 �reQlrn "+erA)vd, lalla�GSSee t=L 323b�' BUST ESS NAME AND ADDRESS Numberand Street) (City) (State) (Zip Code) - ?D I- 1: 3W A 5e) .201- 15 3 TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) Fill out this section if principal.ls a Corporation,Partnership or Trust[Section 2-482(c)] • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY:. JoCt Yee Jam)Q Y'L L� . IDENTIFY ALL PERSONS HOLDING,DIRECTLY'OR_ INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, i PARTNERSHIP OR TRUST: u SPECIFIC 90113113Y ISSUE real ) ►'g t i:�F P b 2-0309 Issue to be lobbied(Describe in detail): ` V TIll.CITYAGENCLESL' D O _ L"`67B 196: 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 eneral nature of the subject contractual relationship. Sec 2482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO title of person to be lobbied I I 0n , Qrn 155JOMot i 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. Sec 2-482(g)Any Financial,Familial or Professional.Relationship F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc I I Prieto, Silvia From: Mireya Carballosa [mcarballosa @flapartners.com] Sent: Monday, May 21, 2012 4:59 PM To: Prieto, Silvia Subject: Re: Lobbyist Registration Attachments: scan ner @barretogroup.com_20120521_154111.pdf Silvia attached is the first page for the Amended Lobbyist Registration for both Brian May and Tim Riera-Gomez. Thank you, Mireya From: <Prieto>,Silvia <SilviaPrieto @miamibeachfl.gov> To: Mireya Carballosa <mcarballosa @flapartners.com> Subject: RE: Lobbyist Registration I do not think is necessary as long as it comes from you as his representative. MIAMI BEACH Silvia Prieto,Administrative Aide I CITY CLERK'S OFFICE 1700 Convention Center Drive,Miami Beach, FL 33139 Phone:305-673-7000 ext. 6269/ Fax:305-673-7254 www.miamibeachfl.gov We are committed to providing excellent public service and safety to all who live,work and play in our vibrant,tropical, historic community. From: Mireya Carballosa [mailto:mcarballosa(cOflapartners.com] Sent: Monday, May 21, 2012 3:53 PM To: Prieto, Silvia Subject: Re: Lobbyist Registration Silvia, I just thought of something—do you need the Amended registration executed by the client? M i reya From: <Prieto>,Silvia <SilviaPrieto @miamibeachfl.gov> To: Mireya Carballosa <mcarballosa @flapartners.com> Subject: RE: Lobbyist Registration Hi Mireya, Please email me a copy of the lobbyist registration with a notation on top to read "Amendment" to change a name of a Co. to a new name. This way I will attach the "Amendment" to the Original Lobbyist/s registrations. MIAMI BEACH Silvia Prieto,Administrative Aide I CITY CLERK'S OFFICE 1700 Convention Center Drive, Miami Beach,FL 33139 Phone: 305-673-7000 ext. 6269/ Fax:305-673-7254 www.miamibeachfl.gov We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,tropical. historic community. 1 , , ...... �`������ ��� � From: MircyaCarba|losa Sent: Monday May 11, 2O1Z 12:08 PM — To: Prieto Silvia Subject: Lobbyist Registration Good afternoon Silvia, Instead of leaving you a lengthy message on your machine, I thought I would write. Our client ACS has changed company name. They are requesting that we amend the name throughout all municipalities. |s there a procedure through the City of Miami Beach in which this can be done, or is itas simple as filing a duplicate registration form with the new company name as follows: Xerox State & Local Solutions, Inc. (F/K/AA[5). Let me know if this is ok. |f you need to call me | will be returning from lunch around 1:lS. Thankyou, Mireya [arbaUoaa Floridian Partners (305)461-4260 ` z . . . -. : • . t4bA ;EA.:H . . M?rrWeacb: �f Qr: OO�fleitkn cat 'Dn, :MtthFte FL 3139 . : Lob manLtp*s mpIoyc.pti.ta�e4, wbWberppkorn*t,by *pjbWpw)o eeje pr pi�dti any WfI9 rQMIO w 4tn ota mitopfi a oJepr CIfn, rmarth,e Mgr * QnygUor1. decsion omtar*�b& 1j4 p�j pjg en�rEegIron:rn ;kbjb1S1�m w recmmendon Threa6 * wThbe 1rd:� r4vfewed bIbt ottimIssJ6n * mp tijI peff1�fly1»jJuffi v MdPI L L1JJfl JQQ j t/2I; J9ani 77m, - - 22J Mop _ �� ff1r» Jawtw yi , jv Jp- oD(Na C •:it2; NAMEo;47IP ;€g d ‚ ';49$ \ 3O9 -' - tt Th bL 'ou Jou I eqJtp � s ¶� P� 4rebprft � - l4R- r4d /fq' eJ ij 4TJ ;;r-f - MW*tO 8&ujO L9Ja 1 n4; Jrn .PQnraCJ Ubn*hI jJ t k L , a r 1 oo r p t6Qflfl I trojnJ* JflQ hi C•JLLLDP'OJOQI :SO*.iIj . .. )J4) ui i dJIJJ vI1 njI a 0 P( Ja1n YS 0 II 'qIpb / I a __ __ 2 O & a4er • PniIabtto ClWCdo tIw*.482Lg) regIstwnuhJ1IbuqdIrJtjje ybfluijn�ss ffPaitI ass flu .rtI�b%hI.$�thrNJatI�n.ekI qMhtWi aJth� nmptojttetjMflu,, krt01ttyt�flhI.d ItJuM vTh� Qtpkt b fobblid abtdOflt f1tbd 3 • S A c ; jrr6t� IRJa1(o W cr . /IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) ,5 cD X00. flo —{ _ B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): -•, /� c , =1 (Required). Qi _ 0 0V - 00 GI C) • "T- The #ollowing Infomnation must be answered: ..,.., 1) Pursuant to Miami Beach City Code Section 2.468 Entitled 'Prohibited Campaign Contributions By Lobb tom' is Giterocapment Issues": © z m -n r 0 Yes No: Are you lobbying on a present or pending bid for goods. equipment or services. or on a pen pending award for goods, equipment or service? -, co 2) Pursuant to Miami Beach City Code 2 -490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues': ri i o• :: e • ,.. .. • . , ' on a ' , . * t • * Ile 0. r .. De eio ► : - a t A : ement CI h or ■ I cap ion for change of zoning map designation or change to the City's Future Land Use Mao? 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. 0 Yes dNo: Are you representing a not.for -proflt 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; E FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. / / . ' . . 1 Si, a . ; oft °. . • 4/ I do solemnly swear that all of the foregoing facts are true an. correct and that I have read or am familiar with the provisions contained in Section 2 -482 of the Miami : fch Ci Code an.. all repo " g requirements. Signature of Lobbyist: �, A j, 1 ilir _ /".II.L41 4 1_,„,. w Signature of Principal/Ciient: d 0 0.4 inialig VI. LOBBYIST IDENTIFICAT * N: PRINCIPAL IDENTIFICATION: -.",11111111111! 0 Produced ID 0 Produced ID Form of Identification Form of Identification e Personally known (Lobbyist) LY Personally known (Principal) VII. SIGNATURE AND STAMP OF NOTAR . = NN E. , I, tiREYACARBAUDS � MtRE`!A CAR BAU EE -BSA ,. MY ON # 22, 2015 �, NIY COMMISSION # 045548 n,�v State of Florida, Count F y of Miami-D. /1,'., . $. 22, 20 State of Florida, County of , `r . ..� p(PIRES: F '� Pu um Sworn to nd subscrib :.. before m p f • E X P IRE NotryP b,^undQnoters _ Sworn a d subscri. I ,,,'-'..1,:.;'''-.1„.1: � o, w This _ • day of / 2 ' '!• eonde This ' ,�€„ •• - d bafo I day - f .. %.4./ • AN........ —it ur4=..7 — --- iii / / Sit n- true o biic No • ry - State of Hari. a S ! rt • ure of blic - State of Florida No.. . rizatio . . Lobbyist's signature No : rizatloi Principal's signature TO SE COMPLET Y CITY CLERK'S STAFF ONLY Annual Registration tee: • I I No Amount Paid MCRa y_ Vi Date Paid d i / ` � [ I � Lobbyist Registration Form received and verified by ` FACLER ; ALLtaFORMS‘LoSBYta' FORT S' Lo byistAnnual Registration Form,doc .. / / Revised 1/1.1/2+ 11. MIAMIBEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachH.gov CITY CLERK Office CityClerk @miamibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 771 LOBBYIST NAME: Rieret - 6/5-inea. 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. f g 3 1 � ALA. / 1 _ .� /I ✓�_ l ature: W Date: