Betty (Beth) C. Ferrero (Sobol) 1 0.5____,e)
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vizi /MIAMI BEACH -r IA I L Frks117 Wigenle.,
RECF.1
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 21NSOV 17 AM 11: 33
LOBBYIST REGISTRATION FORM CITY CLERK'S OFF
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passag ,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 spe ific exclusions. Please refer to rdinance 2004 -3435.
NAME OF LOBBYIST ( ast) First) (M.I)
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BUSINESS NAME AND ADDRE S N (Number and Street) (City) (State) (Zip Code) 3.3.>`-k
TELEPHONE NUMBER: FAX NUMBER: EMAIL.
Please notify this office if your contact information changes: address, phone, or e address.
I. LOBBYIST RETAINED BY• �^ C� N
NAME OF PRINCIPAL/CLIENT C3
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Codes' 1 .—
Ci) 3s'
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL. (Optional) O ..o.. 'n
CD
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)I W
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY' m
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST
II.SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
lll. 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. 1
Sec 2- 482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES NO
\� title of person to be lobbied
V
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
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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_
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): f
(Required). 1N c�Q____
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":
El Yes l!d'No: s" 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 No: Are you lobbying on a pending application for a Development Agreement with the City or application for
chanqe of zoning map designation or change to the City's Future Land Use Map?
3) Pursuant to Miami Beach City Code 2 -484 An
y 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 representinq 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 C • - - ATION RECEIVED. IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHAL BE FILE' - , - THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PE - .• I. '
Adir Signature o • Lobbyist 4
1 do solemnly swear that all oft - • e• g facts are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the '..� : -ach; City 14 -- all reporting requirem -.
ii —
Signature of Lobbyist: `' 'io• —
■
Signature of Principal /Client: ' l 1
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^Produced ID FIZLik Ra —0 0 Produced ID I'Co Gp 0`OFS3-S — o --`j b/ 0
Form of Identification Form of Identification
❑ Personal) known (Lobbyist) 1 r n� ISABEL S
Y ( Y ) �__ - ❑ Personally known ( i iSABEISATCHELL •
:.F.. f • ; �'�
' ' MY COMMISSION q DD 879891 =
- «- • idY XMMISS!ON # DD 879891
EXPIRES. April 13, 2013 ., - EXPIRES: April 13, 201
VII. SIGNATURE AND STAMP OF «. . . IYBonded Thru Notary Public Underwriters ' � pF ,,\ 8aide'1 Thru Notary Public Underwriters
State of Florida, County of Miami -Dade - State of Florida, County of Miami -Dade
Sworn to and subscribed before me Sworn and subscrib d before me
This l day of N 6 , 2011 — ' f day of r b r • , 2011
Signat re of Pu:lic Notary — State of Florida Signature •f Public N. a — State of Florida •
Notar . ation of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETE • :Y CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ] Yeso Amount Paid $ a. i4' . R . , DN - L OF Date Paid / '7
Lobbyist Registration Form rece' ed and verified by: :*Mk 1
F:KLER \$ALL1aFORMS\LOBBYIST FORMS, Lobbyist Annual Registration Form.doc Revised 1/11/2011
CA A 1A AIB
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CiyClerk @miamibeachfl.gov
Tel: 305 673.7411 , Fax: 305.673.7254
c� r
LOBBYIST NAME: ` a
I understand that no later than February 28th of each year, 1 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.
\
Signature: Da -: