Eduardo A. Pardo-Fernandez - Pierre Elmaleh " ^ A
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City of Miami Beach Office of the City Clerk
1700 Convention Canter [)hve. Miami Beach, FL 33130
LOBBYIST REGISTRATION FORM
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Lobbyist means all persona employed or retained, whether paid or nut, by a principal who seeks to encourage the papaoge, defeat or
modification of any o,dinanoa, n000|uuun, action or decision of any commissioner; any oct|on, deda|un, recommendation of the City
xxanage,or any city board or committee; or any acmon, decision or recommendation of any city personnel during the time period of the
entire decision-making pmuoea on such ootion, decision or recommendation that fonaaeeab|vvwx be heard or reviewed by the city
oommiaa/on, or city board or committee. The term specifically includes the principal as well as any employee engaged in lobbying
activities. The L
NAME OF LOBBYIST: (Last) (First) (M.1)
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BUSINESS NAME AND ADDRESS (Number and Street) \J (City) (State) (Zip Code)
_:�OS__300- V43(2 cc�s— 0) C'n V11
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notifv0ia office/f your contact information changes:
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NAME OF PRINCIPAL/CLIENT: -+:3-7
BUSINESS NAME AND ADDRES-S n
,,99er and Street) (City) Jp Code)
___303. _e�M 0�0_\Tft_ VA CIO
TELEPHONE NUMBER: FAX NUMBER:(Optional)I EMAU.(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust(Section 2-482(c)]
a NAME OF CHIEF OFFICER,PARTNER,OR BEN EFICIARY:
0 IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
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CITYAGENCIESANDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Sectio
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
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 Lf
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) b�o.
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). (D
The 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 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
lDevelopment 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.
_Yes VNo: 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 N 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 City Coded a repo rti- e jai ents�
Signature of Lobbyist:
Signature of Principal/Client: F,,.ey 11A
VI. /LO BYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
N uced ID +y is ups '
Produced ID z $ N 8
Form of Identification Form of Identification y LL co
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Personally known(Lobbyist) Personally known(Principal) N 0
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VII. SIGNATURE AND STAMP OF NOTARY: Q W
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State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade W 0 a
J fie. ,20 �. Sworn add subscrib d before me ¢ 2 w
hi � �"''~`'•. BECCA 13RISML S HEZ This day of 1 1C- 201+
MY COMMISSION#FF106752 ` �°.m
igrr > cif Pu is o ary- ate of on a Si nature of Public 00t9ary A-Stal of Florida :•.,N......... P�: i;
santim-com Notarization of Principal's signature ',9
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ es[ -I No' Amount Paid$ • fJ�: CR# Date Paid /`
Lobbyist Registration Form received and verified by:
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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 CityClerk @miamibeachfl.gov
Tel: 305.673.741 1 ,Fax:305.673.7254
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L®BBYIST NAME. �t • � _�
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 Com on Ethics and Public Trust.
Signature Date
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CITY OF MIAMI BEACH
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T HIS INFORMATION MUST B E COMPLETED) ®ffice of Finance Director
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