Ralph Choeff - Ricardo Morales CIO w. DZG4 �r
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)
l &•
BU INESS NAME AND AD P RE S (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
f�-4L4 COP
NA E OF PRINCIPAUCLIENT:
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BUSINESS NA AND%_Eu� RESS (Number and Street) (City) Sta e) (Zip Code)
TELEPHONE NUMBER FAX NUMBER.(Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2482(c)]
• 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:
ILSP'ECIIrIC LOBBY ISSUE:
91.e. Zt& - let It?--
Issue to be lobbied(Describe in detail).
III.CITY AGENCIES/INDIVIDUAL
S 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 clt to the present date,stating the aeneral nature of the sub ect contractual relationship.
Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
title of verson to be lobbied
Pursuant to City Code Section 2482(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 2482 Any Financial,Familial or Professional Relationship
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t IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHE R HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Issues":
_Yes Eft: 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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes�4No: Are you lobbying on a pending application for a Development Agreement with the Clty 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 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.
_YesANo: `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 CLERIC A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES,AS WELL AS COMPENSATION RECEIVED, IN THE_CITY_OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR, I&STATELAENJ SHALL B FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature Lobbyist
I do solemnly swear that all of f e fact ar jue and co ect and that I have read or am familiar with the provisions contained
in Section 2-482 of the Mia ea ode a uirements.
Signature of Lobbyist:
Signature of Principal/Client: _
s Lo f'I S
VI. LOBBYIST IDENTIFICATION: P DENTIFICATION:
Produced ID rl�r,cQL, O(;Vpr`j L I(,-In 4 R�'�c�eA� roduced ID ` 6121 Q �S 11—C
Form of Identification ds 4 Form of Identification �.
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®Personally known(Lobbyist) ��,oq ��� ®Personally known(Principal) ��`°\Cb'
VII. SIGNATURE AND STAMP OF NOTARY: ��oa
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State of Florida, County of Miami-Dade_ a T State of Florida, County f Miami-Dade ��oa
Sworn to and subscribed before me o Sworn and subscribed efor me
aa
This 1�1�t` day of 6(4,#1#e, ,2012 Th' da f ,2012
IVA
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Signature of Public Notary—State of Florida Signs ure f Public N —State of Florida
Notarization of Lobbyist's signature Notarizaflon of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ Yes[ ]No Amount Paid$ 250 MCR# Da Paid
mnay
Lobbyist Registration Form received and verified by:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
Revised 04/27/20
City of Mi0illi 860'. 1 100(rItIvel-111011 Cei ilel Dovc mmuoli,Beck k florldoTi 1,39 v_wti)101(jimbead1l1 qo"-,
(IfY UERK Ofk�_-
Rubel E Gictoodo. Cfly Uet
Tel: 305.673.7411 ,Fax:305.673.7254
Lo omyu sir mAw f., f TI-1,
I understand that no later than (February.28 of each 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) L098YOST EXPENDOTURE AND COMPENSATOGN 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 2-435.1, 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 EtWcs and Public Trust of the failure of a lobbyist(or principal)
to file the Statement or pay the assessed fines after notification.
Any Oobb,yo ho falls to file the required Statement by April 30th, 2012, shall be
autom suspended from lobbying until all fines are paid, unless the fine has been
app e th ia i-D&&County Commission on Ethics and Public Trust.
oil, 1 ?0
to
Sign ture: Date:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook183LGbDDH\Lobbyist Registration
Forwevised 5-30-2012.doc