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MIAMI BEACH
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 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.I)
ADD I've, 2. 5.Tj1.!CAt/N� W4•, STf. t760� AIAKI , �- 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (ZJp Code)
303- H82--8700 72W,0 61W (P A00/We, &W
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office If your contact Information changes:address,phone,or e-mail address.
I. LOBBYIST RETAINED BY:
TA5p rJ j9a1FR K/
-NAME OF PRINC PAUCLIENT:
� �I- 1�@1A lSy K IC C-?a6 12t ICWnI ,psi y 112W
BUSINESS NAME AND ADDRESS (Number and Street) (City) (Slate) ( ip 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: ��N �t
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
u.SPECIFIC LOBBY ISSUE:
Issue to be lobbied(Describe in detail):
Ill.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 jeneral 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
X
k IF
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.
Sac 2-482 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) 60D/
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). /nri 4,OA
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":
_Yes No: Are you lobbying on a present or Pendlna 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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_YesyNo: Are you lobbying on a pending application for a Development Agreement with the City or application for
chance of zoning map designation or change to the City's Future Land Use Map?
3) Pursuant to Miami Beach City Code Section 2-482(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.
_YesXNo• Are you representing a not-for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 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 E FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Sign um- obbyist
I do solemnly swear that all of the f oing facts are true and erect and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Be fi C y Code and all rep n requirements.
Signature of Lobbyist:
Signature of Principal/Client_ ZZ A 1//
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
_Produced ID Produced ID �(Lv-LJS �1 G
Form of Identification Form of Identification
Personally known(Lobbyist) _Personally known(Principal)
SIGNATURE AND STAMP OF NOTARY: O vp1K
0•� N
" 5 to of Florida,County of Miami-Dade �AUf'H�81>�'61 S ' i Dade
cc gg— orn to and subscribed before me pi �KGo �.� bscribed before me / "L
u'l is y of 2012 No' M5 0► s 2012 6'
us� �t
nature o b is o —State of F rida F,Omm Signature of Public Notary— fClew
tartzation of Lob is signatur Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid
Lobbyist Registration Form received and verified by:
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F:\CLEI istro lion Form.doc Revised 04/2AA I
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granada, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.741 1 ,Fax:305.673.7254
LOBBYIST NAME: ON"!W W, d0094.0
I understand that no later than February 28 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, or I am no
longer lobbying on that issue or for that principal, I am required to immediately notify
the City Clerk's Office of lobbyist withdrawal in writing.
Pursuant to Section 2-485 (d), the City Clerk shall notify any lobbyist(or principal)who
fails to timely file a Statement and in addition to any other penalties which may be
imposed as provided in Section 2-485.1, a fine of$50.00 a day shall be assessed for all
Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal)
to file the Statement or pay the assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30th, 2012, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed jUhte Miami-Dade County Commission on Ethics and Public Trust.
�— 6.Atai2
Signatur Date:
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ADD INC
311 Summer Street Boston, MA 02210
DISBURSEMENT REQUEST
Vendor Name: City of Miami Beach - Office of the City Clerk
Remit Address: 1700 Convention Center Drive
Miami Beach, FL 33139
Attn: Sylvia Pietro I Administrative Aide
Sylvia prieto @ miamibeachfl.gov
CHECK REQUESTS:
Vendor ID# Return to Requestor:{X} Hand Deliver{ }
Date Request: 06.25.2012 Overnight{X} Mail { } Other{}
or
CREDIT CARD TRANSACTIONS:
CARD HOLDER:
CARD TYPE:
CHARGE DATE:
INVOICE#
GL# PROJECT i DESCRIPTION TOTAL
NUMBER
12002.00 Lobbyist Registration Issue $350.00
POSTING SEQUENCE NUMBER $ -
Voucher Number $ -
Check NUMBER $ -
Grand Total $350.00
* Please complete all information above and attach all back up. Disbursements will be
processed on or before the date requested.
Department: Accounting Department/Tara President
Approval:
Prieto, Silvia
From: Vanzant Debra [DVanzant @addinc.com]
Sent: Friday, June 29, 2012 9:24 AM
To: Prieto, Silvia
Subject: FW: Lobbyist Registration Form I Jonathan Cardello I Jason Halperin -2360 Collins
Attachments: 20120627113341.pdf
Good morning Silvia— Please confirm the attached lobbyist registration has been filed. Also, please send me a copy of
the filing once you have time.
Thank you!
Best Regards,
Debra Vanzant
ADD Inc Debra Vanzant 1305.482.8701
One Biscayne Tower Suite 1670 Two South Biscayne Blvd Miami, FL 33131 www.addinc.com
From: Vanzant Debra
Sent: Wednesday, June 27, 2012 11:39 AM
To: 'silviaprieto @miamibeachfl.gov'
Subject: Lobbyist Registration Form I Jonathan Cardello I Jason Halperin - 2360 Collins
Hi Silvia,
I will be sending another Lobbyist registration form along with the appropriate fee to your attention via Fedex today(a
copy is attached). Please forward a receipt once you have completed the filing.
Thank you and please let me know if you have any questions.
ADD Inc Debra Vanzant 1305.482.8701
One Biscayne Tower Suite 1670 Two South Biscayne Blvd Miami, FL 33131 f www.addinc.com
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