Eric R. Zichella - BCC Engineering MIAMI BEACH o�
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 refer to Ordinance 20043435.
7 rcrf�Ll,� �fZIC
NAME OF LOBBYIST: (Last) (First) (M.1)
17-2A !�(Zr e tcEl.c v k�vd, �tiRml , rL 3Z / 5 l
BUSINESS NAME AND ADDRESS (Number and Street) (City) State) I (Zip Code)
`796 Yo/ 9000 &z&2 J"3 IVp•�a
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
6 e G
NAME OF PRINCIPALICLIENT: -7 3o® i\ 33/3'
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
(Zi C e)
365-6 70— Z 5o J My Nn Aced It= 'Wa
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 BENEFICIARY: J r\ O 6z I.
a
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: c7 ru
II.SPECIFIC LOBBY ISSUE: 1 m ;I
Issue to be lobbied(Describe in detail): �7?
nl.CITY AGENCIEWINDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4)include the commissioner or personnel sought to be lobbied,and whether fhe 1 66 ist h�entered
Into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months pre�ediWsuch-person's
commencement of service with the city to the present date,stating the eneral nature of the subject contractual relatiomshl .
Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(ExplainFi Cc YES NO
title of person to be lobbied
No tr,31�_
Pursuant to City Code Section 2482(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 Any Financial,Familial or Professional Relationship
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Formrevised 5-30-2012.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) i /Z LJC=e r
B1 PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION" n
The following information must be answered:
•i) Pursuant to Miami Beach City lode Section 2-488 Entitled Prohibited Campaign Cc:ntributionrs By Lobbyists On Procurement
Zo:Yes Are you lobbying on a present or pending bid for goods,equipment or services,or on a present or pending
award for goods.couilament or service?
21 Pursuant to Miami peach City Code Section 2-490 Entitled'Prohibited Campaign Contributions By Lobbyists On Real Estate
D elopment Issues":
—Yes 'JL7o: Are you lobbying on a pendinq 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 Mao?
2; Pursuant to Miami Beach City Code Section, 2-482 (h)Any person (excep m
t those exept fro nn the definition of"lobbyist' as set
forth in Section 2-481 above) who only appears as a representative of a not-fo,--profit corporation or entity :without special
connpensation of ieianbuiser ant for the appearance, whether direct, of Indirect, to evD ess supuori of Ur Opposition to eri,•I
[li/e'Ti, ShAli rcnicter:Ili -the Clerk c5 required by this section but, shall not be required t0 nay any ieuiStiatl0n: fees
Yes1/f o, Are-you Jrepresenting 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 IF THERE HAVE BEEN NO.EXPENDITURES OR
COMPENSATION DURtNC THE REPORTING PERIOD. J
Signature of Lobbyi
:'0 S(ii2.iliiiy S4'dcai Etta`: of the vi,.g,:i ,a..tS c.:iris., and co.iP.Ca and that I have ic3G or or;i fH r il!ci'irif!l the piOViSFC i'rS C'oiit?!i cd
in Section 2-482 of the iv i I Beach -ode nd all reporting requirements.
i
Signature of Lobbyist: �
S►gittureaf �tnC: e�Oit�rt._. 1
V1. LOBBYIST IDENTIFICATION: Rli<fCIPA!:-IDENTIFICAT1Qf`�_ J
✓ Produced ID _ _r nducsd !n_
Form of lGent;ficatlon Form of Itierit!flcal!cn
�Personally known (Lobbyist) IZ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida. County of Mtiami-Dade State of Florida, County o I ii - d
Swom to and subscr!b d before me Swor an u crib o f re me
Tn!S _dG"'of ;?LI': j 1'n" t UUAMR.INATREtD .:S da/nr Public rate of Florida
MY CO3WISSION k EE 844865 L
Q My Commission EE072264
fr EXPIRES;February 1a,z0,7/ i o7 Cp Erpires 04/t012015
t , Bonded ThN Notary Puhlic m A
i ure of Public Notary- ,ate of Flonria ?sur PubI� , otary-
Notarization of Lobbyist's signature ion of Principal's signature
TO BE COMPLETEP BY CITY CLERK`S STAFF ONLY
Annual Registration fee: ] Yes( ]No Amount Paid S —MCR# ate Pal
i Lobbyist.Registration Form received and verified by. � i
l'4Users,clarhatit_Anr.•finial!.or?Ilfvi!CIOSOfiytiLrindrlb S\T2; rJOrAi"'v' ini2rr�i?t ci!cSl Ont°nt Gt;t 001:�� fir'
Remstrati;,n
For-nrevised 5-30-2012.d:c
iistration Form.doc Revised 04 127/2012
MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miami6eachf.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk@miamibeachfl.gov
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME: (Z i C Z1e_RW_z_1,A
I understand that no later than February 23 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 25(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 slue 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 falls 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.
4!!:�K � 2 V11.5
Signature: Date:
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