Marcelo Llorente{I City of Miami Beach Office of the City Clerk 1
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.
NAME OF LOBBYIST (Last) (First) (M.1)
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6USINESS NAME AND ADDRESS (Number and Street) (Citv) (State) I (ZiD Codel
Please notify this office if your contact information changes. address, phone, or e address.
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2482 (c)]
1. LOBBYIST RETAINED BY
Phi Ifo 6 C oo
NAME OF PRINCIPALlCLI NT
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BUST SS f AND ADDRESS (Number and Street) (City) (State) (Zip ode)
TBL E HONE UMBE FAX NUMBER fOptronal) EMAIL. (Optional)
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:
n t1t e T c C i I fl C ri NA% In !/L n ll M A 1.D ►' AA rn 1 n to VVVJ ✓�.� n��
III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED
Pursuant to City Code Section 2- 482(x)(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 subiect contractual relationship.
Sec 2482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES NO
title of penjon to be lobbied
44 U1
W In J VVA a �rhft
PLrt tubi t 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
soug to be lobb as identifie on the lobbyis reg istration form fi led.
Sec 2 -082(g) Any Financial, Familial or Professional Relationship
6Z I Wd 9- 33011OZ
0 A
IV DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER)
A) LOBBYIST
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B) PRINCIPA 'L RE (O_F LC tFr�nS C�
(Required). A '� — i �v + �+-.� 'iF op o
The following information must be answered: �` t
1 } Pursuant to Miami Beach City Code Section 2.488 Entitled 'Prohibited Campaign Contributions By Lobbyists On Procurement
I ssues
❑ Yes 5/Y o 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
change of zoning map designation or change to the City's Future Land Use Map?
31 Pursuant to Miarni 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
SIGNATURE UNDER OATH:
I do solemnly swear that all of the foregoing facts are true and
in Section 2 -482 of the Miami Beach City Code aVTV II r=ortiry
Signature of Lobbyist
Signature of Principa6Client:
VI. LOBBYIST IDENTIFICATION
W :•,
PRINCIPAL IDE T (CATION:
Produced ID
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Form of Identification
Lk�
' 5 Personally known (Lobbyist)
` f1
Form of Identification
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VII. , SIGNATURE AND STAMP OF NOTARY
s, Es
Personally known (Principal)
State of Florida, County of Miami -Dade
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k
Sv✓orn to and subscribed b m
State of Flonda, County of Miami -Dade
rn and subscribed befo a F� ti`•�
is
��
' Signature of Public Notary -State f Flonda
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Notarization of Lobbyist's signature-
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afiNtha '(ave read or am familiar with the provisions contained
atiberits
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ry
PRINCIPAL IDE T (CATION:
Produced ID
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Form of Identification
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i s `wf S% iy
Personally known (Principal)
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<a e•., dfZ
State of Flonda, County of Miami -Dade
rn and subscribed befo a F� ti`•�
is
m>
Signaturo of Public Notary - Sta to 0 orida
Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: t -]Yes[ ] No Amount Paid 9 MCR # Date Paid -
Lobbyist Registration Form received and verified by _ ..
r' tCi.ErTtSA.t f a:Or - >t4U56 "`J0.MS ;Labb}ibt An alk2 pia ?ration form.,!" _ '', Revised'1 /11 /2011'
City of Miami Beach, 1700 cooventlon Cenle, Dnve Miami B•=.acF, Fla, do 33139, viv v�,miam�bcvr.htLc7ov
CuY CLERK Office Ci yCle:kiNmiomibeachN . a.v
Tel: 305 -673 7411 , tax- 305.673.
LOBBYIST NAME
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
Slgna. - - -- - -- - -- Dale