The URL can be used to link to this page

Hamed Rodriguez - Richard Chera MIAM B EACH', 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. V.D V,16xJ�Z 1:0-M E0 NAME OF LOBBYIST: (Last) (First) (M.I) X02 32_50 LA-=Y' S% 4k 3D5 6XV00 7 G�LiF 3.30 3 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 2-4-4 5C2.6 JhAA02a 11'ZcrS-1,Z. ccA1 TELEPHONE NUMBER: FAX NUMBER: E Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOB YIST ETAINED BY: �V, 2 NAME OF PRINCIPAUCLIENT: 76 ( 9" �k 1671;3 B SI ESS NAM AND ADDRESS (Number and Street) (City) (State) (Zip Code) C y00 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: • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II.SPECIFIC LOBBY ISSUE: can� 0r- i�rA-,J E �Z /rt�G- -�'D Issue to be lobbied(Describe in detail): 4 Ill.CITY�►GENCIES/INDIVIDU�►LS TO BE LOBBIED: �� g04 Pursuant to City Code Section 2-482(a)(4)include the commissioner or personnel sought to be lobbied,and whether-the Idbftist has entered into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months Rreced sucil-person's commencement of service with the city to the present date,stating the general nature of the subject contractual relatiQnshi . -'"j Sec u Na a of Individual and Contractual Relationship(Explain)_; YES NO ti on to be lobbied J �. �. J cl~ �9 Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,f8milialW 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. Se ncial,Familial or Professional Relationship F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) ao vr2 L'! AS 9AV=7- OiE 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 Contributions By Lobbyists On Procurement Issues": _Yes •No: obb in on a resent or pending bid for goods,equipment or services or on a resent or a r or 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'V No: lobb in on a pending application for a Development Agreement with the Ci or application for pe 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"asset 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. YesaCo• ou 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 COWEASATION RECEIVED IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL LED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Sign of Lobbyist I do solemnly swear that all of the foregoing facts are tru nd co t and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporti uirements. Signature of Lobbyist: Signature of Principal/Client'�1 - k1 VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID Form of Identification Form of Identification V Personally known(Lobbyist) Personally known(Principal) ®� � VII. SIGNATURE AND STAMP OF NOTARY: � Cr State of Florid,County of ami-Dad State of Florida,County of Miami-Dade Sworn t andfsl�bscribeff before �PR��'B JESSICAACMA Sworn and subscribed before me M This ay of 1W * MY COMMISSION#FF 010901 This -t3kh day of `Op..C.. ,20 Q � a* EXPIRES:May 13,2017 - q Bonded Thru Budget Notary Services / i — f Florida Signature o Public Nota —State of- 4vedV W P4 sign k*zation e of blic Nota State o g Notary Nota o Lobb ist'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 Form received and verified by: F:\CLER\$ALL\a FORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 11/18/2013 I F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc MIAMIBEACH City of Miami Beath, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov CITY CLERK Office Rafael E.Granado,City Clerk CityClerk @miamibeachfl.gov Tel:305.673.7411 ,Fax:305.673.7254 I LOBBYIST NAME: 9AMED �Qj? understand that no later than February 28 of each year, 1 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-X485.1, 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 30, shall be automatically suspended fr m lobbying until all fines are paid, unless the fine has been appealed to the Miami-D de County Commission on Ethics and Public Trust. Signat Date FACLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc Miscellaneous Cash Receipt J CITY OF MIAMI BEACH . No. JAN - 8 2014 0 Cash 0 Credit Card L7 Check# $ 20� y L2, U 4 Received of A124 J Address c� For (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director BY Account Number: Preparer: Dept: EXT: