Monika Entin - Jose M. Lamadrid / M I B EAC H
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 2004-3435.
EpEn r)r)Can
NAME-OF LOBBYIST: (Last) (First) (M.1)
r_&r0(3',,0 'R 7ry--',
BUSINESS NAME AND A DRESS (Number and Street) (City) (State) I (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this orrice.if.your:contact.information-changes:address,phone,-or a-mail address `
I. LOBBYIST RETAINED BY:
'.b.as- tkt- "Je.d_
NA PFh R INC�AUCLIENT:
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/ 7 d4 f LL-G ,
r
BUSiNIESS NAME.AND ADDRESS (Number and Street) (City) )(State) (Zips qpde)
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
I Fill out this section if principal is a Corporation.Partnershio or Trust rsection 2-482(61 !
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:
it SPECIRG-LOBBY ISSC,
COO
Issue to b6 lobbied(Describe in d il):
III ctT.Y AGENCIES1INDIV D.1 LS`Tg B��£}�B1ED::
w..Riid'.uAevl..:..K. >4.,.,c.N»J.. �u....w A...,P2'..,t.IRl,• .> .a.. ._.,x...- .i.h �..'+„'k _..xr„v( .....,...-<.a.aS Sw..... .,.r
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 I Contractual Relationship(Explain) YES NO
title of person to be lobbied
I & - J� :::�Q ( l
t-ttf-�snot (I i-(A (own'?i ss`i 0r) ,a s neP(°
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(g)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) C30
8) PRINCIPAL'S DISCLOSURE(OF LOBEYIS Ct, �A�—,6:
(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 lobbyina 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 o: Are you lobbying on a pendina armlication for a Development Aareement with the City or application for
change of zoning map desianation or chanae to the City's Future Land Use Man?
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 o• Are you representina 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 t EVEN IF T E E HAVE BEEN NO EXPENDITURES OR
COMPENSDA T ION DURiNG THE REPORTING PERIOD.
Signature of L obyist
I do solemnly swear that all of the foregoing facts W_e_tn4e-a4dco rrect and that I have read or am familiar with the provisions contained
in Section 2-A82 of the Miami Beach City Cie nd all reporting re uirements.
Signature of Lobbyist:
Signature of PrincipaKlient: 6G c
Vl. LOBBYIST IDENTIFICAT ON: PRINCIPAL IDENTIFICATION:
roduced ID Qt✓�S CPa`Y� roduced Ib y
Form of Identification IS .,, Form of Identification (r
Personally known(Lobbyist) o' •ic Personally known (Principal)
�%
fill
VII. SIGNATURE AND STAMP OF NOTARY: :'ati o`� *t o•+
sy` � ,�,Da►
State of Florida,County of Miami-Dade / Jamey,�cDb State of Florida, County of Miami-Dade
Sworn to nd subscribed,Def e me '\°° ��o�',��Q®s`' Sworn V subscribe before me �� oo�
This day of y`f'1/ 2012 �o�' k� day t 2012 `r lo
Signa�ur 'of Public Notary—State of Florida �0 �0` � Signatu e of Public N to —State of Florid�, ��a ��
Notariz tion of Lobbyist's signature �'�Q Notari tion of Principal's signature a'���' D ��
TO BE COMP TED B CITY CLERK'S STAFF gNLY
Annual Registration fee:.[ ]Yes[ ]No Amount Paid MCR# ate Pai
Lobbyist Registration Form.received and verified by
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FaCLEi iistratioa Form roc
evised 04/27/2012
City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachF(.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk@miomibeachfi.gov
Tel: 305.673.7A 11 ,Fax: 305.673.7254
LOBBYIST DAME: 010 P�r�G •
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.
pui-.�uan ILO 1. 24 X85 , C st or principal) Who
r���uaii� �v j�GUL7f� �-��� (ca), T.�a lal� �+i�ri� ..i�aii nt3;�`<;1 any io�byi� �
s addition other penalties which may be
fails to timely file a Statement and in addi�ion to any p
unposed as provided in Section 2-485.1, a fine of$50.00 a day shall be assessed for all
e notify the Miami-Dade
Statement(s) filed after the due data.. The City Cl�..rk shall n fy
r principal)
• of a lobbyist or p )
County Commission on Ethics and Public Trust of the failure y ( p
to file the Statement or pay the assessed fines after notification.
Statement b Aril 30th, 2012, shall be
lobbyist, mho fails to file the required S y p
Any ,
automatically suspended from lobbying until all fines are paid, unless the fine has been
appeale d to the Haml-Dade Count Commission on Ethics and Public Trust
�y
Signature: bat
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