Eric R. Zichella - Lincoln Road Property Owners Assoc. I AN\I B EAC
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 3314131�ov _8
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LOBBYIST REGISTRATION FORM
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Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage'the'passeige-defeat or
modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of file City
Manager or any city board Ior 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 foreseeabiy 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.
16
NAME OF LOBBYIST: (Last) (First) (M.1)
?3 1221 A
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code))44 fW
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes: address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
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NAME OF I I PAUC T: fnr-O 0
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BUSINESS NAME AND A DRESS (Number and Street) (+ity) (State) (Zip CA
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] A�
• NA OF CHIEF OFFICER, PARTNER,OR BENEFICIA
ID NTt ALL PERSONS HOLDING, DIRECTLY OR I ECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
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PARTNERSHIP OR TRUST: Pj`f V r
II.SPECIFIC LOBBY ISSUE:
Issue to be lobbied(Describe in detail):
nI. CITYAGENCIESIINDIVIDUALS 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 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
Pursuant to City Code Section 2-482(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(g)Any Financial, Familial or Professional Relationship _
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- •w DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION DISCLO
( SE WHETHER HOURLY,FL
A) LOBBYIST DISCLOSURE:(Required) AT RATE OR OTHER):
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Co
Issues": Contributions By Lobbyists On Procurement
_Yes : Are ou lobbying on a
resent or endin bid for oods, a ui ment or services, or on a resent or endin
award for goods, equipment or se
._cr vice
2) "
Pursuant to Miami Beach City Code Section 2-490 Entitled Prohibited Campaign C
D �elopment Issues": Contributions By Lobbyists On Real Estate
_ Yes o: Are YOU lobbyina on a endin 11 a lication for a Develo meat A reement with chan a of zonin ma desi _nation or chan a to the Cit 's Future Land Use Ma �
the City or application for
—3)---- -Pur`suant�to-�Miami Beach City Code Section2=482- h O An
forth in Section 2-481 above) who onl a Y person-(except those exempt from 'the definition of"lobbyist"as s
Y ppears 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
i em, shall register with the clerk as required by this section but,shall not be required to a an
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_Yes_No: Are ou re resentin a not-for- rofit cor oration or entit wi thout s ecial pay Y registration fees.
com ensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY
OATH LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATION RECEIVE
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILE CLERK A SIGNED STATEMENT UNDER
COMPENSATION DURING THE REPORTING '
EPORTING PERIOD. D EVEN IF THERE HAVE BEEN NO EXPENIDITURES OR
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Signature of Lobbyis
I do solemnly swear that all of the foregoing facts are true and correct an
in Section 2-482 of the Miami Beac d that I have read or am familiar with the provisions contain
� �y Code and all reporting requirements. ed
Signature of Lobbyist:
Signature of Principal/Client: --- -
VI. LOBBYIST IDENTIFICATION: _
PRINCIPAL IDENTIFICATION:
Produced ID ;�• B °1:
.k
Produced ID
Form of Identification "I
Form of Identification
®Personally known(Lobbyist)
$° o Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY: �z cn
State of Florida,County of Miami-Dade o i
Sworn to, r subscribed
This , re'me y State o /�orida, County of Miami-Dade
day of 201 T " Swo end subscribed before me
a
� y T g Gar of
� 2012
Ni n fur' Notary State of Public Nota
– of Florida
otar`ization of Lob`�signature f P
Si re of Notary y–State of Florr a
No ization of Prin_lal_s signature
TO BE COMPLETED B CITY CLERK'S STAFF 0 L
Annual Registration fee: [ ]Yes No Amount Pai
9 ...__......._-._.._._...-- --—_.._._ .....
Lobbyist Re istration Form received and----vrified b CR#
Y� � - — - - -- Date Paid
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F:�CLEI JiAratiof Form doc Revised 04/27/2012
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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
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LOBBYIST NAME: f/Z 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.
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, 20122 shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Mi ' ounty Commission on Ethics and Public Trust.
Signature: D e:
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