Jaie Laplante , moot
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m MI AMIBEACH
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 foreseeabiy 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
Laplante Jaie
NAME OF LOBBYIST (Last) (First) (M.I)
Miami Int'l Film Festival /MDCF 300 NE Second Ave #5521 Miami FL 33132
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305- 237 -3654 305- 237 -7344
laie @miamifilmfestival.com
TELEPHONE NUMBER FAX NUMBER EMAIL.
Please notify this office if your contact information changes address, phone, or e-mail address.
LOBBYIST RETAINED BY
As above
NAME OF PRINCIPAL/CLIENT
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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'
II.SPECIFIC LOBBY ISSUE.
Miami Beach VCA grant application /Miami Dade College Foundation
Issue to be lobbied (Describe in detail)
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
VCA Grant Board • : - - _ — X
Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extent of any busine f ncl I, fen�pd a or pqrpp�J¢¢ssional
relationship, or other relationship giving rise to an appearance of an impropriety with any current city i:drhrlrl ioer br'elt peobttel who is
sought to be lobbied as identified on the lobbyist registration form filed. 7 r1
Sec 2- 482(g) Any Financial, Familial or Professional Relationship_ LZ •Z1 Wd 6- AON 11OZ
No
2
IV DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY FLAT RATE OR
OTHER)
A) LOBBYIST DISCLOSURE. (Required) Non —pro f i t
B) PRINCIPAL S DISCLOSURE (OF LOBBYIST COMPENSATION)
(Required). Non —prof 1 t/ $ 0
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"
Il Yes LNo. 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 Et 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 ❑ No. Are you repreeentinq 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 N IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
//144/6
Signature of Lobbyis
I do solemnly swear that all of the foregoing f. • are truand correct and that I have read or am familiar with the provisions contained
in Section 2 -482 of the Miami cb City o• - : nd a report g requirements
Signature of Lobbyist: / / Gib
Signature of Principal /C nt; �f'����
VI LOBBYIST ENTICATION PRINCIPAL IDENTIFICATION
❑ Produced ID ❑ Produced ID
Form of Identification Form of Identification
a Personally known (Lobbyist) Personally known (Principal)
VII. SIGNATURE AND STAMP OF • • ,
State of Florida County of Miami - Dade ; ' Ne N I g r RVtLL A. S HOLYFIELO S :te of Florida County of Miami -Dade
Sworn t nd subscribed before me s y PuWlc ' Slate of Florio ern subscribed befor me
This day of /(/L .. ( ,x,201 . `� "Mr f:NrM Jan 21, 20t is `f day of �(/,�v,2011
.1:411 • r. . Q •S •z..a. at . # MM aI Noh y i�nI . .� • a -5 ( C /�
S *nature of Public Notary — ''- of Florida ig a e •f •ublic Notary — State of F orida
Notarization of Lobbyist's s gnature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee [ 1 Yes [ ] No Amount Paid $ MCR # INAO'/FA' Date Paid t/
Lobbyist Registration Form received and verified by
_F• \CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc _ � ' ,� � ' Revised 1/11/2011
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City of Miami Beach, 1700 Convention Center Drive Miami Beach, Florida 33139 www miomibeachfl.gov
CITY CLERK Office CityClerk @m iamibeachfl.gov
Tel 305 673.7411 Fax 305.673 7254
LOBBYIST NAME Jaie Laplante
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 f have registered to lobby on has been resolved, I am required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing
% 11/04/2011
Sig •ture Date