Wayne M. Pathman - Robert Zangrillo ado
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City of Miami Beach Office of the City Clerk E� -1 . 3 �; 44
1700 Convention Center Drive, Miami Beach, FL 3 A
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LOBBYIST REGISTRATION FORM I I I `a (_L L_'�'ti S u 1=' F I C F.
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.
Pathman Wayne - M.
NAME OF LOBBYIST: (Last) (First) (M.1)
Pathman Lewis, LLP, 2 South Biscayne Boulevard, Suite 2400, Miami, FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-379-2425 305-379-2420 wpathman @pathmanlewis.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Robert Zangrillo
NAME OF PRINCIPAVCLIENT:
Robert Zangrillo, 60 SW 13 Street, #4602, Miami, FL 33130
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-281-7383 boba-zangrillo.com
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] NOT APPLICABLE
• 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:
II.SPECIFIC LOBBY ISSUE:
11 E DiLido Dr- Demolition of existing home & construction of 12, 868SF single family home w/ increases
Issue to be lobbied(Describe in detail):
lll.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
Planning and Zoning Department X
Design Review Board X
Mayor and City Commission X
Pursuant to City Code Section 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 commissioner or city personnel who is
sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2-482(8)Any Financial,Familial or Professional Relationship
NOT APPLICABLE
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
I
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required)
' $500.00 Per Hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): 500.00 Per Hour
(Required).
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":
O Yes Q 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 Estate
Development Issues":
® Yes Q No: Are you lobbying on a pending application for a Development Agreement with the City 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 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 section but, shall not be required to pay any registration fees.
® Yes 0 No: Are you representing 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 SHA FILED EVEN IF THERE HA E BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD. --_.
Signature of Lobby'
I do solemnly swear that all of a foregoing facts are true and rect and that I h am familiar with the provisions contained
in Section 2-482 of the Miami B c ode and all re
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFI ATION: PRINCIPAL IDENTIFICATION:
iv
4E Produced ID T € Produced ID
Form of Identification o w C Form of Identification
J
Personally known(Lobbyist) € Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY: W
State of Florida,County of Miami-Dade State of Florida, County of Miami-Dade
Sworn to and subscribed before me :Qa• ,�: Sworn and subscribed before me
This day of ,201 gj,: This day of ,2011
ignature of Public Notary—State of Florida Signature of Public Notary—State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
A. TO BE COMPLETED BY CI Y CLERK:§STAFF O Y It A
Annual Registration fee: [ ]Yes[ No Amount Paid$ MCR# Date Paid
FACLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyisf Registration Form.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required)
$500.00 Per Hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): 500.00 Per Hour
(Required).
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 lobbvinq on a present or pending bid for goods,eciuipment or services,or on a present or pending
award for goods,eciuipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
® Yes Q No: Are you lobbvinq on a pending application for a Development Agreement with the City 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 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 section but, shall not be required to pay any registration fees.
® Yes No: Are you representing 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 OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach City Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFI A O PRINCIPAL IDENTIFICATION:
Produced ID € Produced ID
Form of Identification Form of Identification
€ Personally known(Lobbyist) € Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn to and subscribed before me Sworn and subscribed before me
This day of , 2011 This day of , 2011
Signature of Public Notary—State of Florida Signature of Public Notary—State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
ACKNOWLEDGEMENT
State of California )
County of Los Angeles )
On �° 3 , before me, )Opt(1 to Le,a a Notary Public,
personally appeared � �►'�' Zr ,04 4.4k LL y who proved to me on the
basis of satisfactory evidence to be the person(&) whose name(,e) is/ar-e subscribed to the within
instrument and acknowledged to me that he/she/grey executed the same in his/her/they authorized
capacity(ies), and that by his/ /their signature(j}on the instrument the person(#Y, or the entity
upon behalf of which the person'acted,executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the
foregoing paragraph is true and correct.
JORGE J.HIDALGO
Commission# 1930300
WITNESS my hand and official seal. z -_ Notary Public-California > _
Los Angeles County
My Comm.Expires A r 12,2015
Signature (Seal)
Lohhvict Ranictratinn Fnrm rocaivart and varifiarf hw
F: =orm.doc Revised 1/11/2011
City of Miami Beath, 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
LOBBYIST NAME: Wayne M. Pathman
I understand that no later than February 28th ®f 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, 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 to the Miami-Dade County Commission on Ethics and Public Trust.
Signatur Date:
FACLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc