Daniel G. Ciraldo - MDPL 6222 Alton Road �AIAMIBEACH
City of Miami.Reach,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 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.l)
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BUSINESS N E. . . DRESS- (Nunter and.Street). (City)- (State)- (ZIP Code-)
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TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact informadon changes:address,phone,or a-mail address.
1. LOBBYIST RETAINED BY: p
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NAME OF PRINCIPAUCLIENT: O Igo I& k-9,4, 'rj 3�111___0190
BUSINESS NAME AND ADDRESS (Number and Street)) (City,) .(State) q1p Code)
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) �1
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Fill.out.this..section.1f 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,
PARTNERSH P OR TRUST.
11.E`p s r LOBBY SSUE., " P 3 F 1
6�q*( q Issue to be lobbied P6scribe in detail): �w
IIL C"'A� �SfiNDMDUAL$TO BRIG,D:
Pursuant to City Code Section 2482(9"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 general nature of the subject contractual relationship.
Sec 2482(a)(4),Fult Name of'Indhrid-ual'and' Contractual Relationship(Explain) YES NO
1 tide of perp9n to bojobbled
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Pursuant to City Code Section 2-I82(g)Every registrant shall be required to state the extent of any business,financial, 111"professional
relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner or-city p-onnal who is
sought to be lobbied as identified on the lobbyist registration form filed. –
Sao 2 Anv Fkuvwlial Famiiga!or Professional Rion
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F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLO E WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) I
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":
_Yes No: Are you lobbying on a present or pending bid for snoods,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 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-REC-EIVED,-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.
Sign re 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 Mia i Beach City Code and-all-repo 'ng equirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Y_Produced ID 4Lase
Form of Identification Form of Identification ry
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Personally known(Lobbyist) _Personally known(Principal) Fs.#
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida,County of Miami-Dade of Florida,County of Miami-D`gde ER
Sworn to and subscribed before me , "�.� '.••; SORATERRAZAS 'S n d subscri f re me }
This off ,201 MY COMMISSION#FF 105OWhi day f ,20 , � ^'
EXPIRES:March 25,2010 •• °`�
• �ti, '„ d'•` Bonded Thru Notary POW UnderwMeni
Sign t e Publi No a —State of Florida Signature of Pu i N ary— "Pte of Florida CD
Notarize n of Lobbyi is signature Notarization of pal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee:. [ :]Yes`.[ ]No Arnount Paid$ MCR# :Date Paid
Lobbyist Registration.Form received and verified by:
F;1CLER.1$ALL\aFORMS\LOSBYIST FORMS\Lobbyist A6nua6 Registration Form.doc Revised 01/22/2014
F:ICLERI$ALL1aFORMSILOBBYIST FORMS1Lobbyist Registration Form.doc
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I Al I B E A H
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.micmibeachf.gov
CITY CLERK Office
Rafael E. Granada, City Clerk CityClerk @miamibeachfl.gov
Tel:305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME:
I understand-that no-later-gran-February-211 of-eachryear-, I must file the-foNnwing 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 fallur-e-ofa 4obbyistIor-principal)
to file the Statement or pay the assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30th of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
7pe d to th e Miami-Dade County Commission on Ethics and Public Trust.
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Signature: Date:
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