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City of Miami Beach Office of the City Clerk f;I T It/ r`i l-E'
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 a uslons. Please refer to Ordinance 2004.3435.
NAM F LOBE I T: (Las (First) (M.1)
CY s��f 4 P� 33 e VO
SINE SS NAME AND ADDRE S (Number and Street) (City) (State) Zip Code)
)67
TELEP NE NUMBER: FA NUMBER: EMAIL: "►/
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST TAINED BY:
S� 12C4Zn
E ZP IN CIPAUC ENT:
JES NAME AN AD RESS , (Nu r n( treet (City State) p o
4TP�f
P E NUMBER: FAX MBER:(Optional) EMAIL:(Optional) •�-{J
Fill out this section if 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,
PARTNERSHIP OR TRUST:
Ii.SPECIFiC LOBBY ISSUE:
e�20,2 Ve 0_z?4;��
Issue to be lobbied(Describe in detail):
Ili,CiTY AGENCI ES/IN DIVI DUALS: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 unpald) 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
ti a of person to be lobbied
I Vol'
C? I've)
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 Any Financial,Familial or Professional Relationship
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) 4%0%la
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): �OO .
(REQUIRED). (J
The following Information must be answered: !�
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
ztj,,u Yese you lobbying on a present or pending bid for goods,equipment or services,or on a present or ep ndina
award for goods-,equipment or service?
2) Pursua o Miami Beach City Code Section 2-490 Entitled"Prohibited Campalgn Contributions By Lobbyists On Real Estate
De opment 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 Wami Beach City Code Section 2-482(h)Any person(except those exempt from the definition of"lobbyist"as set
forth ,tion 2-481 above) who only appears as a representative of a not-for-profit corporation or entity without special
comp sation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any
/o: shall register with the clerk as required by this section but,shall not be required to pay any registration fees.
Yes re 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 SUB IT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH LISTING LOBBYING EXPENDITURES AS WELL AS COMPEASATION RECEIVED IN WE CiTY OF MiAMI BEACH
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAV9 BSEN NO EXPENDITOSS OR
COMPENSATION DURING THE REPORTING PERIOD,
IlAlb4lVtl�
Signature of Lobb st
I do solemnly swear that all of th foregoing facts are tru and correct and read or am familiar with the provisions contained
in Section 2-482 of the Miami B ch City ode and all o equ're ?0`1—avie
Signature of Lobbyist: -;; % Q
Signature of Principal/Client' h&a /)&; &W te"
k". &4 at IL sme- -.0 .
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VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID — Produced ID
Form tification
Farm of Identlfi tlon
Personally known(L byi�q Personally known(Principal)
��e`ti
s
ViI. SIGNATURE AND S
State of Florida,County of Miami-Dade State of Florida,County of Miami-Dade
Sworn to and subscribe efore me Sworn and subscribed before me
This /!C ay of 201 , This day of 201_
ig ature of Public Notary— at of Florida Signature of Public Notary—State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annuaf Registration fee: .[ ]Yes[ ]No :Am*aunt'Pald$, MCR `:° ..:..'.. :: [safe Paid
Lobbyist Registratlon•Form.redelved and verlfled by:
1+:\CLER�$ALL\aPORMS\LOBBYISr PLIRMS\Labtiyist Annu 1 Reglsttitioiiisrm.ciiic. Revised 01/-22/2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbylst Registration Form.doc
/V� l AM, I B EAC H
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfi.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk @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" of each year, shall be
automatl�ally suspended from lobbying until Ines are paid, unless the fine has been
appealed to the Miami-D a unty om sion n Ethics and Public Trust.
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Signature. Dat
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