Daniel G. Ciraldo - MDPL 1729 Lenox Ave. Cuban Hebrew/ Ple-4 1729
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City of Miami Beach Office of the City Clerk
1700 Convention Center Dhve, Miami Beach, FL 33138
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by principal who seeks to encourage the paaaoge, defeat or
modification of any oruinance, reao{uuon, action or decision of any commissioner; any acmon, decia/on, recommendation of the City
Manager or any city board or committee; or any acmon, decision or recommendation or any city personnel during the time period of the
entire decision-making process on such action, decision or recommendation that foreaeeob|vvwx be heard or reviewed by the city
commission, or city board or committee. The term specifically includes the principal as well as any employee engagedin lobbying
activities. The terng"Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435
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NAMEOF LOBBYIST: (Last) (First)
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BUSINESS NAME AND ADDRESS (Number and Street) (city) (State—) (Zip-Code)
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TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address. '
/. LOBBYIST RETAINED BY:
BUSINESS M )QFL-
NAME OF PRINCIPAL/CLIENT:
— NAME ANQAD SS
,,,tumber and Street) (City) (State) (Zip Code)
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:
o.SPEC| ' ISSUE'
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Issue to be lobbied(Describe in detail):
III.CITY AGENC|ES/ N[>|\/|DUALS TO BE.LC]BB' [>:
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 m/ouonomn (num or unnom} with said ouv 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 2-4820)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
title of per,%on to b2llobbied
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Pursuant to ' Every registrant required' to state—'extent of any business,-- financial, '~'
relationship,o,other relationship giving rise to on appearance"ranimpropriety,with any current city commisomne�-u ouj-_pemo«r�el 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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F�\CLER\$ALueFORMSx'OBBY|ST FORMS\Lobby|st Registration Fomn.doo
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER/HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) Y y/
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B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). /vo c�ho.✓ /
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".
V
—Yes ANo: 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":
—Yesk— o: Are you lobbying on a vending 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 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 cleric as required by this section'but,shall not be required to pay any registration fees.
Yes—No: 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 RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signatur of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami PA ach City Code and all rep ing r uir ments.
Signature of Lobbyist:
Signature of Principal/Client-
V1. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
_Produced ID _Produced ID
Form of Identification Form of Identification
V Personally known (Lobbyist) Personally known(Principal)
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VII. SIGNATURE AND STAMP OF NOTARY: '�' ULIAM R HATFIELD= MY COMMISSION#EE 844865
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.• EXPIRES:February 18,2017
State of Florida,County of Miami-Dade State of Florida, dpi ; fi W&WTB 19l"PublicUnderwriters
Sworn to and subscribed before Sworn and sub
This day of 4 014 This day of F Pa
nature of Public Notary–Stat ignatu of Public Notary–State of Florida
Notarization of Lobbyist's sign "'Y�i%''•,, I.IIJAMR.HATFlEID ,
•• MyCOM;vIISSION#EE 844865 otarization of Principals signature
►: -
•••••• February 18,2017
iC RK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ""
# it Date P id
Lobbyist Registration Form receive and verified by:
F:tCLt ?t,r .== t?S�I � ?Tt DtS L�bt;ris t ens F 1 y Revise 11/182013
s `l r..'i;^FS3:•.I� S�isl`l�ri :JIiSIrGC'SC
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach,Florida 33139,www.miamibeachfi.gov
CITY CLERK Office
Rafael E. Granado,City Clerk CityClerk@miamibeochfl.gov
Tel: 305.673.741 1 ,Fox:305.673.7254
LOBBYIST NAME:
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 30, shall be automatically
suspended from lobbying until all fines are paid, unless the fine has been appealed to
the Miami-Dade County C mission on Ethics and Public Trust.
Signature Date
FACLER\$ALL\aF0RMS\L013BYlST FORMS\Lobbyist Registration Form.doc