Samuel J. Dubbin - Vera Mender 2013 APR I AM 11: 54
City of Miami Beach Office of the City Clerk ")`�y L t{� ; 0�7 f I i,.
1700 Convention Center Drive, Miami Beach, FL 3313
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained,whether paid or not, by a principal who seeks to encourage the passage,defeat o
modification of any ordinance, resolution, action or decision of any commissioner, any action, decision, recommendation of the Cit
Manager or any city board or committee;or any action,decision or recommendation of any city personnel during the time period of thr
entire decision-making process on such action, decision or recommendation that foreseeably will be heard or reviewed by the cil:
commission,or a city board or committee. The term specifically includes the principal as well as any employee engaged in lobbyinc
activities The term"Lobbyis "has specific exclusions. Pluase refer to Ordinance 2004-3435.
Uu t;n CAMilr,I T
�y,AME OF LOBBYIST (L�sf) (rust) (M 1)
k6h n � Nvd-z LAP 1X00 41Aa P5-;o, /lt-AHe 5�. 30o Coral 6Wes- FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (Slate) (Zip Code)
'105) X 71-l j`7 00 (30S) 3?1-47()1 4
st:�bbi& hen kraye�-z .�aM
TELEPI IONS NUMBER FAX NUMOCR •FMAIL
Please notify this office if your contact information changes:address,phone,or e-mail address.
I. LOBBYIST RETAINED BY: //
IlL(G► Mehdfr
NAME OF PRINCIPAVCLItNI�02"U P6 6 srt 1y P Mir;lni , Y ���J
BUSIZE,(?na�Q�CI_R `t INumber and Street) (City) (State) (Zip Code)
TELE F10NE NUM13ER: Cj�( FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section if principal Is a Corporation,Partnership or Trust[Section 2-482(c)] 1 � r& /) e'vi /e
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: V I N1 d
• IDENTIFY ALI.PERSONS HOLDINfjWRECTLY OR INDIRECTLY,A 516 OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
LSPECIFIC LOBBY ISSUE- Rdn6W "A Gonfi* a /^+'F5' `�`S�++e/uic o�
�MD ot, IS 0\5i e4 L96S of Otecon Ar,.V On Aa"tw Silt Of AZ Qfkke`nn�,niw"f 14110 oeeat or vex
ssue to be lobbied(Describe in detail):
ii.CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
'ursuent to City Code Section 2-482(a)(4)Include the commissioner or personnel sought to be lobbied,and whether the lobbyist has entered
ito any contractual relationship(paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's
onmtoncoment of service with the city to the present date.stating the oneral_naturo of the subject contractual relationship.
Sec 2.482(aX4)Full Name of Individual and Contractual Relationship(Explain) YES NO
title of Qerson to be lobbied
NAL
ursuant to City Code Section 2-482(8)Every registrant shall be required to state the extent of any business,financial,famlllal or professional
rlationshfp,or other relationship giving rise to an appearance of an Impropriety,with any current city commissioner or city personnel who Is
)ught to be lobbied as Identified on the lobbyist registration form filed.
ec 2.482(g)Any Financial.Familial or Professional Relationship
:%UserslderhatllAppData%LocallMicrosoftlWindowslTemporary Internet Files%Content.Outlook183LGQDDH\Lobbyist Registration
)rmrevised 5-30-2012.doc
F:\CIEI jistration Form.doc Revised 04/27/2012
MIAMBEACH
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: k�l �• N4iA
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 a Miami-Dade County Commission on Ethics and Public Trust
Signature: V Date:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc