Harvey Hernandez - Newgard Development Group, Inc. rl
MIAMI BEACH V
City of Miami Beach Office of the City Clerk F8 ��
1700 Convention Center Drive, Miami Beach, FL 33139C,/-,1r11 Ff
LOBBYIST REGISTRATION FORM ;
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, dk&t.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.
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NAME OF LOBBYIST: (Last) (First) (M.1)
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BUSINESS NAME AND AD RESS (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.
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAUCLIENT: aw 6,744,_ pr(Ar' -3303 5,7 15',00
BUSINESS NAME N DDRESS (Number 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: k*WG� �2k>kJW-'
• IDENTIFY ALL PERSONS HOLDING,DIRECT Y OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: WAY& 0V?(PX14PQ11
II.SPECIFIC LOBBY ISSUE:
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Issue to be lobbied(Describe in detail):
III.CITY AGENCIES/INDIVIDUALS 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 Contractual Relationship(Explain) YES NO
title of person to be lobbied
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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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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) (D(Y ar
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): A�u4j,!
(REQUIRED). CC::
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
`/Is-sues":
_Yes-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":
4Yes_No: 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.
_YesVo: 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 COMPENSA ECEIVED IN THE<ITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILEWT2aN IF THERE HAVt BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signatu of L byist
I do solemnly swear that all of the forego/fa are tru or ect and that I have re or a miliar with the provisions contained
in Section 2-482 of the Miami Beach City all re orting r irements.
Signature of Lobbyist: Zi
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: P NCIPA)ID NTIFICATION:
Produced ID ced ID
Form of Identification Form of Identification
Personally known(Lobbyi t�:o�aa!°o� M CRISTINA DE CASTRO Personally know S a) M CRISTINA DE CASYI>O
,
Y COMMISSION#FF011101 ' MY COMMISSION#FF011101
VII. SIGNATURE AND STAMP Zz
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EoF�o, EXPIRES April 23,2017 111
State of Florida, County of Miami-D 7)39&0153 FloridallotaryService.com State of Florida, Cou FloridallotaryService.com
Sworn t and subscribed b fore me Sworn and subscribed before me
This day of FghrIWtI,20 1 his day of ,201
ignature of Public Notary—State of Florida gign_a�ture of Public Notary—State of Florida
Notarization of Lobbyist's sure arization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAF ONL
Annual Registration fee: [ es[ ]No Amount Pa' $ MCR Date Paid
Lobbyist Registration Form received and verified b : .
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I AAA I BE AC H
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
LOBBYIST NAME: -V,
I understand that no later than Februanj 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.
`Il) LOBBYOST 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 2-45501, 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
(bounty Commission on Ethics and Public`rust of the failure of a lobbyist(or principal)
to file the Statement or pay the assessed fifes after notification.
Any lobbyist, who fails to file the Irequ° ed Statement by April 30th, 2012, shall be
automatically suspended from lob until all fines are paid, unless the fine has been
appealed to the Mia ads Cou Commission on Ethics and public Trust.
Signature: Date:
FACLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
Miscellaneous Cash Receipt t�.� ► F �� 4.a�}w�t � :�
CITY OP AAIMI _/EACH
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0 Cash D Credit Card Check#
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Received.of
Address ,
For. C J p i .t=� `) 5 f `t ms's :, . e fC
(THIS INFORNfAYiON MUST,BE CONtPLETED) Office' .of Finance Director
BY
Accounf Number:__ %°.
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MIAMI B
Cit y of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfi.gov
City Clerk's Office
Tel: 305-673-7411
Fax: 305-673-7254 Office Use Only
ANNUAL LOBBYIST REGISTRATION FORD
Name: 6, 29AAffy k)*%Jt -z
Business Name: e-toif -� peyewnkL-x,.� GrylvKe oo+c
Address: U wnz*� A<Vr 1-t1 j"r l✓L
Office Telephone Number:
Cellular Telephone Number:
Email Address:
If more than one lobbyist,please list:
1)
2)
3)
4)
5)
6)
7)
Submit this form to the Office of the City Clerk, along with a check for $500 for each
lobbyist. Please make the check(s) payable to the City of Miami Beach.
For City Clerk's Office Use Only
MCR#:
Amount paid: Date paid:
Processed by: Date:
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