Eric R. Zichella - Lincoln Center Association, LLC MIAMI BEACH
City of Miami Beach Office of the City Clerk �Q
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.
1-1C_ ELI 1E.
NAME OF LOBBYIST: (Last) (First) (M.I)
F3 fAta A&0:0Qb 1221 6e(e-g- s- Avrr::,%'4at> /AA KL 3313(
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip e)
125- 3'y'7--51kd c__7(91)P3-11.4•dt_ "
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone,or e-mail address.
1. LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT: r �od �
730 d .Q✓.�- .
BUSINESS NAME AND ADDRESS (Number and Street) (C (State) (Zip Code)
7 3
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 BENEFICIAJRY: 1�,>Owz
co -=rp
• IDENTIFY�vaLjPERSONS HOLDING,--DIRECTLY OR INDIRECTLY,A 5%_OR.MORE.OWNERSHIP-INTEREST IN SUCWQORPORATION,
PARTNERSHIP_ORTRUST: - — -- Ui -0
O -�
II.SPECIFIC LOBBY ISSUE:
Issue to be lobbied(Describe in detail):
III.CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: /eQyde/ /Ilse
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 neral 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
V or
d
l
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 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) J
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): ,A
(REQUIRED). I'C>.
The following Information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Iss s":
_Yes Are you lobbying on a Present or Pending bid for goods,eauiament or services,or on a Present or Pending
Z
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":
s_No: Are you lobbying on a pending application for a Development Agreement with the City or ar)r)iication for
change of zoning mar)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
Z o: shall register with the clerk as required by this section but,shall not be required to pay any registration fees.
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 BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature of Lob gist
I do solemnly swear that all of the foregoing facts are true and correct and that 1 have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach Ci ode and all reporting requirements.
Signature of Lobbyist:
Signature of Principal%Client?
VI. LOBBYIST IDENTIFICATION: RINCIPAL.IENTIFICATION_--
y/Produced ID !/X �J l� _Produced ID
Form of Identification ' Form of Identification
_Personally known( + ' j Personally known(Principal)
VII. SIGNATURE AND N9f f
•;,fi;�,•••�FkajRF Mis�oH9TFjF� _ � �
State of Florida,County of Miami-Da msy Few�fFea� i State of Florida,County of Miami-Dade
Swom to a subscribed before me
Sworn and subscribed before me
This��da of ,20�j �N,•:. This day of ,2012
Y eiM r:;
Sign ture of Public otary—Slate/6f Florida Signature of Public Notary—State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETE BY CITY CLERK'S STAFF O LY
Annual Registration fee: [ ]Yes[ No Amount Pajd$ MCR# Date Paid
Lobbyist Registration Form recAlvelf and verified by.
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
�•V�,f� G� ��srfdc /s
9) PRINC,lt=AL'S DISCLOSURE(OF LOBBYIST.CONIPENS,, ION): �„ � �. ,
(REQUIRED). : �•1 C ;!:' II"`?r�j 1--4
l
The following information must be answered:
1) Pu[SUani to%,liami Beach Cit,Code Section 2-488 Entitled`Prohibited Campaign Confribuiions By Lobbyists On Procurement
_Yes_ Are you lobbyin on a present or oendina bid for eogds,eguiRment or services.or on a:�esent or Rending
award for goods.egu_pment or service?
2) Pu suant to Miami Beach City Code Section 2490 Entitled"Prohibited Campaign Coniributions By Lobbyists On Real Estate
Development Issues':
�( _No: Are you lobbying on a pending application for a Development Agreement with the City or application for
5hangg'g1`aoniho'map designation or change to the'Citv's Future Land Use Map?
3) Pursuant4o Miami Beach Ciiy Code Section 2-482(,1)Any person(except those exempt frorn the definition of'tobbyisi'as sel
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
Z01 ,shall register with the cleric as required by this.section.but,shall not be required 10 pay any registration fees.
Yes Are y ou re resenti at=f r- rofrt a gn or anti ithouf s ial com rise i n or reimbursement
V_ SIGNATURE,UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR EACH LOBBYIST SHALL SUBlYllf 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 EN IF.THERE HAVE BEEN NO EXPENDITURES OR
COh1PENSATION'DURIPiG THE REPORTING PERIOf]. `
.Signature or L y;st
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 2482 of the Miami Beach City-Code and all.reporting requirements_
Signature of Lobbyist: "r
Sigftaturesa' .a,�alfG�®rlf.-;� .,-�
VI. LOBBYIST.IDENTIFICATION: " ' 'PR I__ICIPAL.IDENTIFICATION:
=A
Produced ID � _Produced,ID _--
Form of Identification ,µr Form of Identification
^Personally known(Lobbyist) + = Personally knomrn,(Princlpal).
VII. SIGNATURE AND STAMP OF NOTARY: `.0
State of Florida,County of Miami-Dade State of Florida;County of Miami-Cade
Sworn to and subscribed before me �I Sy ar, wbscribed before me
This day of _,2012 4d of tgA RC& ,201?)
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Signature of Public Notary—,State of Florida Sio re of Public Notary—State'of Florida
Notarization of Lobbyist's signature otarization of Princioal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ).No Amount Paid S tdfCR-# Date Paid'
Lobbyist Registration Form received and verified by.
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F;\CLEI Iistration Form.doc Revised 04/27/2012
MIA.MIBEAC
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov
Tel:305.673.741 1 , Fax: 305.673.7254
LOBBYIST NAME: 1� R_ 42 Z tag,5FLC.4
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 to the M' -Dade County Commission on Ethics and Public Trust.
Signature: D e:
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