Roberto Sanchez Coast Lead Construction, Inc. N�!AMl 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 efer to Ordi a e 2004-3435.
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NAME OF LOBBYIST: (Last) (First) (M.I)
BUSINESS NAME AND ADDRESS c(Number and Street) (City) (State) (Zip Code) I L�
TELE15HONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone;or e-mail address.
I. LOBBYIST RETAINED BY:
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NAME O P IN L/ LIENT: j ✓
14—toe 4 BUSI ME AND A ujer 1d Street) (City) (State) (Zip Code)
TELEPHON 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: !�,J�l �v ����(�►/"
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY QR INDIRE TLY, 5%OR MO,5j OWNERSHIP rjTF ST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: /' yx�
ii.SPECIFIC LOBBY ISSUE:
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Issue to be obbied(Describe in detail):
nl.CITY AGENCIES/INDIVIDUALS 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 city to the present date,stating the general 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
C i � lG
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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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Formrevised 5-30-2012.doc
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(Required). �✓�. '�lY� 14uNrXt.60 �Ott.�(N,S
The following information must be answered:
1) P rsuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists
n Procurement Issues":
Yes ❑No: 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 2-490 Entitled"Prohibited Campaign-Contributions By Lobbyists On
Real tate Development Issues":
El Yes No: 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 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
sec ion but,shall not be required to pay any registration fees.
❑ Yes No: Are you re resentin 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 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
BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES O OMPENS EPORTING
PERIOD. l
Sig6dure of Lobbyist
I do solemnly swear that all of the foregoing facts are trues a that I have read or am familiar with the
provisions contained in Section 2-482 of t i ach Cii�y Co a all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID _Produced ID
Form of Identification Form of Identification
• R.HATFIELD Personally known( SSION#EE 84486 ersonally known(Principal)
February 18,201 otary Public Underwriters
Vll. SIGNATURE AND
State of Florida,County of Miami-Dade State of Florida,County of Miami-Dade
Sworn to and subscribe A before me Sworn and subscribed before me
This _day of 201 This day o 6 201, ,!(, Mr�31LYN ROSE
o
M• * MY COMMISSION#DD 897108
Signature of Public Notary—State of Florida Signature df Public Rotary—State,8 V EXPIRES:October 7,2013
Notarization of Lobbyist'7rTO ture Notarization of Principal's signatk to FLOC\ Bonded Thru Budget Notary Services
BE COMPLETED BY CITY CLERK'S STAFF O LY
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form 2010.doc Revised 05/05/2010
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.741 1 ,Fax:305.673.7254
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LOBBYIST NEE:
I understand that no later than February 28th ®f each year, I must file the following
form, pursuant to Section 2485 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.
3-
Wture: Date: