Domingo "Bob" De La Fuente - Belinda Meruelo t I C;
L, Spa V_)0 `�
s
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.j�Please refer to Ordinance 2004-3435.
de !/i
NAME OF LOBBYIST: (Last) (First)U (M.1) ff
T•�7 �.v/�p n,®., i'_� i '-Pif[ �rlc Lp >zA Qo t�.�.u.� . 1 S4� 'P�.� �1 i m m� . �.�aJ 1.31
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip ode)
Lam. ) 43L- II1-0 1&S) ��-(Iito i ,&A i �QP11 .�"M
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes: address,phone,or e-mail address.
I.(�LOBBYIST RETAINED BY: 'l �J
&J II A - k/vlol n 1 Vlr'c P_/_R c(rin_t%A a�0��c�mor,�, �PruPl,r, 0_cx4 -irVi4e�1 -Scll►
NAME OF PRINCIPAUCLIENT: / e_-tk-t -
1f1Pn�er{. , Pnr _'�1f11 r/-)jjlrin Qt )n✓tc10 . L,�l1Qrn1 1 a 1140
BUSINESS NAME AND ADDRESS (Number and Street) (City) p (State) (Zip Code)
�� k'3t�s- 1,.-j sr) (+-,) a�n�— k 1/1 j I
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: rJ I ,Z /` aW(/
• IDENTIFY ALL PERSONS HOLDIN DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: f l{/
II.SPECIFIC LOBBY ISSUE:
�� n(o a�n�- �c on I' I r�1U �1 C}�/i� ®dn,i�l)ca.�l tJ/1r,rt/C� Gnu PI1[ nn P ✓ocI a.cJ.a �nrvtQ/i�
Issu to be lobbied(Describe in detail):
�-P—co.�s+ ro r s 0%rti ee[f-,P_n �ctA+ Po(ot 1 c h,.e ca S
III.CITY AGENCIESIYN�UIVIDUALS 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 eneral nature of the subject contractual relationship.
Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES I NO
title of person to be lobbied
ci /S'
Cv h
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 ,
in p 1
via
C:\Users\clerhatlWppData\Local\Microsoft\Windows\Temporary Internet Files\Content. utlogk\83LGQDDH\Lobbyist Registration r
Formrevised 5-30-2012.doc /
4 �y�,
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) �
�e a
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). 4 co (Lo ko,o f
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 01o: 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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes lklo: Are you lobbying on a pending application for a Development Agreement with the City or application for
TT change of zoning map 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
item,shall register with the clerk as required by this section but,shall not be required to pay any registration fees.
_Yes 0o: 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 RECEIVEM IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FAEID EVEN IF TMERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Sign re of Lobbyist
I do solemnly swear that all of the foregoing f re true a correct and that I have Ueadoam familiar with the provisions contained
in Section 2-482 of the Miami Beac ity Co porti g requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
_Produced ID _Produced ID
Form of Identification Form of Identification
ersonally known(Lobbyist) _Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida,County of Mi i, ( ELIZABETH BERNARDO State of Florida, County of Miami-Dade
Sworn to and subscrib d befo Commission#EE 070972 Sworn and subscribed before me
This h3 day of - Expires April 16,2015 This day of ,2012
90Med T=Tmy Fin Kwreme 900.385.7019
igndWre of Publi6 otary—State of Florida Signature of Public Notary—State of Florida
Notarization of Lobbvist'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
Lobbyist Registration Forth received and verified by:
C:\Users\clerhathAppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
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) 91 -L-(le-3 n a l x:lg
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED).
The following Information must be answered:
1) Pursuant to Miami Beach City Code Section 2488 Entitled'Prohibited Campaign Contributions By Lobbyists On Procurement
Issues":
_YesOo: Pre you lobbying on a present or pending bid for goods equipment or services,or an a Present or Aendina
award for noods,ecluipment or service?
2) Pursuant to Miami Beach City Code Section 2490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
Yes l�fo: Are you lobbvl a on a nending appllcation for a Development Agreement with the CI or appllCatlon for
TT change of zonina map deslanatlon 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 21181 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 + o Are you representing a not-for-profit corporation or entity without special compensation or reimbursement.
V. 'SIGNATURE UNDER OATH:
ON FrzI3RUA1RY 28 OF E C WCA0. CAe-H LOB YIST SHALL SUBMIT TO THE C CLERK A SIGNED STATEMENT UNDER
MP N IO RECEI HE C O MI CAC FOR
OATH,L TI S EL S C
THE PRECEDING CALE D yFAg. A STATEMENT BHA HAVE BEEN NO EXPENDITURES O
COMPENSATION DURING THE REPORTING PERIOD
S19-naffire of Lobbyist
I do solemnly swear that all of the foregoing f re true correct and that I have ead o am familiar with the provisions contained
In Section 21182 of the Miami Bea ity Cc porti g requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
_Produced ID o Produced ID
Form of Identification Form of Identification
ersonaliy known(Lobbyist) _Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida,County of Ml ELIZABETH BERNAFiDO State of Florida,County of Miami-Dade
Swom to and subscri d befo sa Comrnlsslon#EE 070972 Sworn and subscribed before me
This /3 day of Expires AprD 16,2015 This day of 2012
sm,aea nw nor�,�cu�o anseramo
Ign of Publl otary—State of Florida Signature of Public Notary—State of Florida
Notarization of L I 's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Reelstrallon fee: I I Yes[ I No Amount Paid$ MCR# Date Paid
Lobbylat Regletration Form received and verified by:
C:\Users\clerhatPAppData\Local\Microsoft\Windows\Temporary Internet Fifes\Content.Outlook\83LGQDDH\Lobbylst Registration
Formrevised 5-30-2012.doc
■
-
/ 9 ; '0 : . E
2 _ / ' / _
/ 2 0
\ / .
� / �
$) : ■
§
\ 0
;5
§ : �kE \
\ co ( o
\_0 c ' 171. 's k / ..
§ � � » . , % ■ � 2@ �
u
2 ) / _
� » §
LLI / o _
J.2 7 \\ /
■ / / \ O ® % E
D CL :3
z
w / E % 2 / \\ . to
Z \ \
e
�
« §
-- ■ ` � ° °
2s ■ t ) { «
g / 7 }
■ } /�k / { / k E k -
� kks f8 ol§cz \cc/ � f § )O
■ E � � � > � ±
k - � \
D ° \ U) 3 §
—
rc E / o A 0
LL \
F:\CLEI listration Form.doc Revised 04/27/2012
M I A/\/A\ 11BA, E A Lj
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Gronado, City Clerk CiWerk @miamibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: n"Q
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 FORAM
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) fled 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 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 iami-Dad ounty Commission on Ethics and Public Trust.
;�/i3�� ,
Sig ture: Date:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Con tent.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc