Daniel G. Ciraldo - MDPL 1060 Ocean Drive 0
NAIAMIE
City of Miami Beach Qfrice of the City Clerk 0
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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-rnaking 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 p c exclusions. Plea a refer to rdinance 2004435.
NAME OF LOBBYIST: (Last) (First) ] (M.I)
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BUSINOSS,NANIE AND ADDRESS Street} City) } (Zip Code)P f F ,
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TELEPHONE NUMBER: FAX NUMBER: EMAIL: — V- i
Please notify this office ff your contact information changes:address,phone,or e-mail address.
1. LOBBYIST RETAINED BY:
M r)f I
N AME OF PRINCIPAL/CLIENT:
BUSINESS NAME AND ADDRESS (Number and Street) 1 (City) (State) (Zip Code) (/
TELEPHONE NUMBER;- ab� AX NUMBER:(Optional) EMAIL:(Optional) �� I
Fill out this section If principd Is a Corporatkrd,Partnership or Trust[Sew 2482(c)l
• 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: � D
wSPECIFIC LOBOY IrSSUE: �1 P
Dove-
Issue to be lobbied(Describe in detail):
III.CRY AGENCIESAND UAL S TO SE L.0881ED:
Pursuant to City Code Section 2-4E 616 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 cm,missioner or personnel from 12 months preceding such person's
commencement of service with the city to the present datq,stating the enerall 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
Pursuant to City Code Section 2482(g)Every registrant shall be required to state the extent of any business,financial,familial or professional
relationship,or other relationship glving 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 248 Any Finuanciai Farnillai or Professtonai RaWlanship -
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f
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSAIJOV( ISCLO WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) /� 0 )
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATI N):
(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 V 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
evelopment Issues":
_Yes_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 cleric as required by this section but,shall not be required to pay any registration fees.
Ves—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.
Signat f 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 B City Code and all reporting recauirements.
Signature of Lobbyist:
Signature of Principal/Client.
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identification
Personally known(Lobbyist) Personally known(Principal)
VII. SIGNATURE AND STAMP O SOFIATERRAZAS ��:'ry`'y. SOFIA TERRAZAS
•' '
MY COMMISSION#FF 105996 :A MY COMMISSION 0 FF 105996
EXPIRES:March 25,2018 EXPIRES:March 25,2018
State of Florida,County of Miami-Dade y;pf :�' Bonded Thro Notary Public Underwriters State of Florida,County ed Thru Notary Public Underwdtem
Sworn to nd subscribed befo a me Swom d subscrib d t
This da ,201 This day of ,201
Signa ublic N ary–late of Florida Signature 9mu c Not –State of Florida
NotarkatioU of Lob 'st's signature Notarizatio f rinci al's signature
TO BE COMPLET BY CITY CLERK'S STAFF ONLY
Annual Registration fee: Yes[ ]No Amount Paid$ MCR#AIP1 Date aid
Lobbyist Registration Form received and verified by-
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µ :iz:3^..e�
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.9ov
CITY CLERK Office
Rafael E.Granada, City Clerk CiyClerk @rriiomibeachfl.gov
Tel: 305.673.7-411 ,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 tamely 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 mi-Dade County Commissio on Ethics and Public Trust.
Signatdre Date
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