Daniel G. Ciraldo - MDPL 1801 Collins Ave - -H. 0
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive Miami Beach FL 33139 r'
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' specific exclusions. PI a refer t Ordinance 2004-MS..,
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NAM OF LOBBYIST: (Last) (First) (M.1) 33
_14 qy,BUSINESS ROME AND ADDRESS Number and Street) (City) (State) 91p(Zip Code)
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TELEPHONE NUMBER: FAX NUMBER: EMAIL'
Please notify this office if your contact information.changes:address,'phone,or e=rnad address
1. LOBBYIST RETAINED BY:
NAME OF PRINCIP LIEN Wer ,M \ _ _ fL r BUSINESS NAME AND ADDRESS 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 2482(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:
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Issue to be lobbied(Describe in detail):
Ill.CITY AGENCIES11NDIVIDUALS TO BE LOBBIED:
-Pursuant to City Code Section 2.482(a)(4)include the commissioner or personnel sought to he 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 eneral nature of the subject contractual relationship.
Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
title of perpon to be lobbied
Pursuant to City Code Section 2-482(8)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 Any Financial,Familial or Professional Relationship
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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 Cit,/Clerk@miamibeachfl.gov
Tel: 305.673.7411 ,Fax: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 Commission n Ethics and Public Trust.
Signature Date
FACLER\$ALL\aF0RIVIS\L0BBYlST FORMS\Lobbyist Registration Form.doc