Marcelo Llorente - David Martin 120 Ocean Drive, LLC 1 r 1
1
I
1
I
I
I
City of Miami Beach Office of the City Clerk
I
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, resolutior:, 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 durinn 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.
�'f t
NAME OF LOBBYIST: (last) (First)
�.y (
BUSINESS NAME AND ADDRESS (Number air id Street) (City) (State j {Zip Code)
/ IY` �_�. ,. - t'; , "(-�`:� :•� 'S�..,"• 1.tp'1 � �`; r` %
1
T tEPHOW!NUMBER.- FAX WIVIBER. EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
1. LOBBYIST RETAINED BY:
NAME OF PRINCiPAUCLIENT:
�. .,� I t.. I;•.". ..� 7r �t'f t I i W , i�t 4' .1[ a�' 3.•j '`. t .�,r....
BUSIN SS NAME AND A DRESS I (Number and Street !
(Ciiy1 ) (State) (Lip ode)
TELEF3-IONE NUMBER: FAX NUMBER:(Optional) EMAIL.:(Optional)
---..._..------—- - -.-..........................
_-.
FFdl out this section if principal is a Corporation,Partnership or Trust(Section 2-482(c)) 1
• NAME OF CHIEF OFFICER,PARTNER.OR BENEFICIARY.-
• j I
•
IDENTIFY ALL PERSONS HOLDING,DIRE.C;TLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
wSPECIFIC LOBBY ISSUE:
Issue to be lobbied(Descr a in detait):
rll.CITY AGENCIESIINDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4)include the commissioner or porsonnel 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 ctit to theprosent date,stating t_he_goneral nature of the subject contractual relationship. _
Sec 2482(a)(4)f=ull Name of Individual and Contractual Relationship(Explain) �YES NO
title of persop to be lobbied _ _
AA
.......
i �j�r t:t r y- �• 1 } j �
.�.
CI J I ty
{
f
t ;
_ �" i tom,••
_._—. t 1
Pursuant to City Code S ction 2-482(8)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 cornmissionor or city personnel who is
sought to be lobbied as Identified on the lobbyist registration form filed.
--..................__-.---------------
rSec 2-482Sg)_anx Financial,Familial or Professional Relationship
U
-----��,� _-_...._.-...............
i
...• .
UL Nvr ern
C:lUsers!c'erhatllAppDatalLocaltMicrosoft\WindowslTemporary intern t Iles Qoiai�i= t ,look W LGQ DDH\Lobbyist Registration
Formreviseci 5-30-2012.doc
S
IV. DISCLOSURE OF TERMS AND AMOUNTS op LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE onoTHER):
� /* LOBBYIST oISnLoSunc'(RmnuImm e ) \
............ ----------'---' |
B) pmwo/nALe DISCLOSURE(ur LOBBYIST COMPENSATION)--
u/ so
mso m )____-__--___--_-_-]��
The following information must upanswered: }
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Carripaign Contributions By Lobbyists On Procuirerilent '
Issues":
vou �� �
� — ���' �o' |
award for goods,Qquipment or service?
4 Pursuant m Miami Beach City Code Section 2-490 Entitled"Pmhibitedo@n-ipaign ContrilbutionaBy Lobbyists On Real Es*lal,&
Development Issues"-
mm_wcx Are you lobbying on a pend:i_nq application for a Development A_qreement with the City or application for
chanc
phation or c ange to the City's Future Land Use Map?
3) PUrStial'itm Miami Beach City Code Section c482(NAny person(OxCeptthose exempt fron- the def nitionof'uobyist"as set. /
forth in seomy 2-481 above) who only appears as onopemoomuve o, a not-for-profit corporation or entity *hnvut ooacm| |
cmnpeooutmm or m/mbmcmment for the appearance, whatno/u|mct. or .nmemt, to oxnn,a, support mo,opposition to any '
item.shall register with thp clerk as required by this section but,shall not be required to pay mny registration feoo |
_voudm
-without sp&c�ial compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDF-R
06TH, LISTING LOBBYING EXPENDITURES,AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.,
_.__--- byi
/un solemnly swear that all ormoforegoing facts are trup,and correct and that 1 have fead oramn fam-fliar with the provistions contalnec, |
in Section 2-482 of the i
Signature of Lobbyist.
Signature of Principal/Client: L/
VII, LOBBYIST IDENTIFICAT)l N: PRINCIPAL IDENTIFICATION:
|
Produced ID Produced 0 |
Form mmenmnoaom` Form of Identification
/personally |
fn Commission#EE 178
My Commission Expires
VII. SIGNATURE AND STAMP OF NOTARY- rn Lo
ca K Z April 30, 2016
'rhis icily of . 291 Z M This d a, of: 201-2/3
Signature of Public Notary-State of F16rid@ OD
Notarization of Lobbyist's signature Not-firizai tion of PrinclgaPs signature
TO BE COM ---ej CLERK'S STAFF ONLY
Annual egIst on fe� -Kt Date Pa,
� /
|
C 'tcierh oa|om|cmuoftvwmuowy\Tnmnonarym/ometpiles\oon6�,t.0m/ooxeoLs Or)o*uo uvistnooi,ounon �
� --re- 5-30-2012.doc
_
�
� |
�
F:\Ct_Owl iistsation Ferm.doc Revised 04/27/2012
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:
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
falls 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 to the Miami-Dade County Commission on Ethics and Public Trust.
ai
S gna Date:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc