Daniel G. Ciraldo - MDPL 5324 Pine Tree Drive Rei+ TL,)213 Z 3 a3o 5 3 2`'( 'Rime.
MI BEACH
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 foreseeabiy will be heard or-reviewed by the ate►
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 pegific exclusions. Plea a refer to rdinance 20043435.
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NAME OF LOBBYIST: l (Last) (First) (M.I)
Y00r4- LRCXNe'�-O? s - h •�
BUS S N AND ADDRESS (Numbq&Street). City) te} (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify thPs otiffce if your contact information changes:address,phone,or e-mail address.
1. LOBBYIST RETAINED BY:
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NAME OF PRINCIPALICLIENT: PO ttX. 19��0 /"J 3 J b g()
BUSINESS NAME AND ADDRESS `" (Number and Street) ( y� (�) �t'[ep Code)
TELEPHONE NUMBER: AX NUMBER:(Optional) EMAIL:(Optional) v I
Flit out this section If principal,Is a Corporatiod,Partnership or Trust[Sew 2492(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:
u.SPECIFIC LOBBY ISSUE:
rl-� 3 'D
Issue to be lobbied(Describe in detail):
III.CITY AGEN CIEWII DIVIDUALS TO BE LOBBIED:
"Pursuant to City Code Section 2-48Aa)(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 data,stating the general nature of the subject contractual relationship.
Sec 2-482(a)(4)Full Name of individual and Contractual Relationship(Explain) YES NO
Ube of Person to be lobbied
F"V%� 0.
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Pursuant to City Code Section 2-482(8)Every registrant shall be required to at 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.
Sac 24$ Any Financial Familial or Professtonai RelIaMmship
A. . I,aii P o, �• t "1
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FACLERULLWORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHE HER HOURLY,FLAT RAT OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
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":
_Yesk_No: 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":
_Ye4No: Are you lobbying on a pending 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 clerk as required by this section but, shall not be required to pay any registration fees.
Vyes—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.
Signature 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 Beach Cit Obde=uirements.
Signature of Lobbyist:
Signature of Principal/Client
Vl. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
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Form of Iden_ ca o 22 Form of Identification
Personally known(Lobbyist)_ z : ®®® Personally known(Principal����` �IPNIEIq
y 409 ��°°GpIMISS1pN• ,"Y �i
VII. SIGNATURE AND STAMP OF�, Ist Stagy
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State of Florida, County of Miami-Dade '/�zl��e�•STan�3;\��`�� State of Florida, County of Miaffli,ZDa � �� •
o to nd subsc"efore 1111l1l Swor nd ubsc be r 9� ; *EE191g0g :T i� day 201 This ay o IStsra�e°•°••Q��.\:
GB(�C,STATE�F ��`��`
ign ure of blic o ary—S ate of Florida Signa re ublic No ary—State of Florida �JJJJ111111111\`\\
Notarization of Lobbyist'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:
:'; . t 1 , Revised 01/22/2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc