Julio Pulido - First on Jefferson LLC f x i j
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL V MB --3 P
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LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encoura4� Ae4as��ge, 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.
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NAME OF LOB YIST: (Last) (First) (M.1)Jv/io Pv rdo A►�r.L11fe 12721 51'.0 F� 33175
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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TELEPHONE NUMBER: FAX NUMBER: EM L:
Please notify this office if your contact information changes: address, phone, or e-mail address.
1. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CLIEN .
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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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: VARCO
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
ii.SP..EC.IFIC,LO,BB-�(`ISSU.E
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Issue to be lobbied(Describe in detail):
nl CITY AGENC:I:ESIJNt�IVIDUALt"T 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 eneral 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
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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 DISCL'JSUR= (Required) IVO APQI Tl0144L /OtAltlaolvS, _710ey — —
Bi PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION)
(Required) lk6 AD.D1�V. - ,CJ77(�{
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists Or Procurement
Issues":
Yes Na Are you Iobbyinq 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 N Are you Iobb ing nn a nPndina application for a Development Agreement with the Cfty 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 �914o• 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 TH CITY CLERK A SIGNED STATEMENT UNDER
OATH LISTING LOBBYING EXPENDITURES AS WELL AS COMPENSATHON R CEiVED IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED E EN I THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
S,gr,aWr� or
I do solemnly swear that all of the foregoing facts are true and correcl a d that ha e read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach City Code and all reporting requiro. nts.
Signature of Lobbyist-.
Signature of Principal/Client: dYIA
VI, LOBBYIST IDENTIFICATIO PRINCIPAL IDENTIFICATION:
Produced ID _Produced ID
Form of Identification Erm ov I entification
Person o
Personally known (Lobbyist) a ¢ G� �� i itn aP e
PLOV90 030:S31�IdX3 '
VII. SIGN T ' AND S"0teLGITZNOTA Y: P69 33#NOISSIWW00 Alta
MY COMMISSION#EE046923 u'®��A�yO2
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State of-ion of UMM 2014 St of-.Misr -.D de
Sworn t d ust State Insurance Swo a subscri before me
This a T his ay of ���.
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Si bfic Notary- State of Florida Signa i Notary- State of Florida
Notary ion f Lobbyist's signature No iza ' of P nci al's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONL _
Annual Reciistr ion fee: Yes [ ] No Amount Paid CR# Date Paid
Lobbyist Registration Form received and verified by:
L�=R', 4€ .`,a=Ut?r+��,L:?S�`.'I�' C:) �! \L0Mn.1iS'.AnnU, eaistratror�a�_aoc Revised 1/11;'2011
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, WW1A,.m10mibeachfl.90v
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.741 1 , Fax: 305.673.7254
LOBBYIST NAME: juli6 Polido
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: