Mario De Leon - Rene Gueits l AtV, 1 B EACH
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 foreseeabl
commission, or a city board or committee. The term specifically includes the principal as well s will
an y employee engaged bylobby city
activities. The term ' bbyists" hZ specific exclusions. Pleas efer to Ordinance 20D4-3435.
�D
NAME OF LOBBYIST: (Last) (First)
16 7 9/) A/ A� A 11
(M.I)
BUSINESS NAME AND ADDRESS (Number and Street) (City) ,
IL(5 P_� 2 (State) (Zip Code)
Z q- S Z
TELEPHONE NUMBER: FAX NUMBER W�
EMAIL:
Please notify this office if your contact information chan s:.address, phone, or e-mail address.
1. LOBBYIST RETAINED BY:
7 c_Y�_ L
NAME OF PRINCIPALICLIENT,
BLlSINrr, HND APDRE�SS �O ( J( `l ^
bs � (Number and Street) �a(City q Code) —
�� 4i E
NUMBER: FAX NUMBER: (Optional) E �i
EMAIL: Optionaq
Fction If principal is a Corporation,Partnership or Trust(Section 2-482(c)]
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 F C LOBBY'
Issue to.be lobbied(Describe in detail): �-v
Ill.MW AGEN:CTESLINDIVIDUA BE 1-03B]ED:
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
commencement of service with the c to the resent date,stating the general nature of personnel
he subject contractual relationshi receding such person's
Sec 2-482(a)(4) Full Name of individual and
Contractual Relationship (Explain) YES NO
title.of rson to b lobbi d
Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any dsiness,finan ial,familial or professional
relationship, or other relationship giving rise to an appearance of an impropriety,with any current i c i io
sou ht to be lobbied as identified on the lobbyist re istration form filed. b; � _�3°�gifttersonnel who is
Sec 2-482 An Financial, Familial or Professional Relationship
v�L�= U3AI �� ��
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LOBBYIST COMPENSATION (DISCLOSE WHETHEP.HOURLY, FLAT RATE O
IV. DISCLOSURE OF TERMS AND AMOUNTS OF
OTHER):
A 75BYIS� J'SCSR= (Required}
' " U II��
3; PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMP=NSATION)
(Required)
The following information must be answered:
�) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement
_ Issues"
resent or
_ Yes _ No Are ou Vobb in on a resent or ending bid for oods, a ui merit or services or on a endino
award for goods equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
Devei ment Issues
Yes ' No: Are ou lobb in on a a lication for a Develo merit A reement with the Ci or a lication for
change of zoning maD designation or change to the CitV's Future Land Use Map?
Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of"lobbyist" as set forth it
3) ors as a representative of a not-for-profit corporation or entity without special
Section 2-481 above) who only apps
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 ou re
resenting a not-for-profit cor oration or entity without s ecial compensation or reimbursement. .
V. SIGNATURE UNDER OATH: ALL
ON FEBRUARY 28th OF EACH AR. EACH
AS WELL AS COMPE STATION RECEIVED,VED EN THE CITY OF MiAM BBEACH FFOR
OATH LISTING LOQaYING EXPENDITURE
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES O
COMPENSATION DURING THE REPORTING PERIOD.
n 777
do solemnly swear that II of the foregoing facts are true and correct a d that I have read or am familiar with the prov!sions co^ arned
in Section 2-462 of the Mi mi Beach City Code and all re rting require ents
Signature of Lobbyist:/
Signature of Principal/Client
PRINCIPAL IDENTIFICATION:
VI. LOBBYIST IDEN IFICATION: �/ /
?,/Produced nnll ��la 8�-,3ya- o !J Produced ID
. ID ��Ov' Forms t" 9,
Form of identification
\PM R.HqP �y�
_ ❑ Personalty kno�h ( too,r tiF l0
J Personally known (Lobbyist) �arY 18NF.. `O =
VII. SIGNATURE AND STAMP OF NOTARIt:Z �••2O,m•: �yod#DD832367
Miami-Jade o:•10 #DD 832367 * State of=londa
State of=iorida. County o`. %9<'•:2e0�uedmm . �•: Sworn and subscribb
�s/AG�.;°�biicUnde:;.•�pQ�`. This y `
Sworn tc//���r�,,d subscribed o fore me `e day of ✓ ����
This 7�`� day of-L 1 201 1-' j TAT I-
State of Florida Signat�oftPubhc Notary State f Florida
Signature of Public Notary Notarization of PrinciRal's signature
Notarization of Lobbyist's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
ate aid
Annual Registration fees [ ] Yes [ ,
No Amount Paid 5 MCR# / P
Lobbyist Registration Form received and verified by: p Revised 1111;2011
ER\S4L..a=0F3R'S',i086':TS�=JRM.S\LOts[s!iS Annua'Reuist,-atior Four.lot
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, WW\,v.miamibeochfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 3Q5.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: Xlvl� n
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, 1 am required to
immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
Signature: ate: