Daniel G. Ciraldo - MDPL 8 W. Rivo Alto M[AM- .[BEAC1"H:
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City of.Miami_Beach.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.1)
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BUSINESS NAME AN . DRESS. (Nu r and.Street). (City)- (State) I (Zip Code)
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TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify'this office if your contact in>ROrrtiallorr,changes:aC(ftss,phone,or a-mall address
1. LOBBYIST RETAINED BY:
MDR
NAME OF PRINCIPAUCLIENT: E
BUSINESS NAME AND ADDRESS (Number and Street) (City) '.(State) (Zip Cade)
TELEPHONE NUMBER. FAX NUMBER:(Optional) EMAIL:(Optional)
_
Fill.out.this.seWon.lf_principal.fisa on-Partnership_or.Trust[Sectfon.24a2(c)]-
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A S%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
or
Issue to be lobbied(Describe in detail):
Pursuant to City Code Section 2-42(a)(4)include the commissioner or personnel sought to be iobied,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 S&to the present da allUng the generW nature of the sub ect contractual relationship.
Sec'2-482(b)(4),Fult Name of-lndlvidual'and- ContractuafReladonship(Explain) YES NO
tide 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,familial5or professlonal
ralationahip,*other relationship giving'rise to an appearance of an Impropriety,with any.current city commissioner or city onnel`who is
sought to be'lobbled as Identified on the lobbyist registration form filed. ; =
Set:2 Any Finance Farniilal or Professional Relatlon
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCL S WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED).
The following,information-must be answered:-
1) Pursuant to Miami Beach City Code Section 2488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Issues":
_Ye4o: 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 2490 Entitled Prohibited Campaign Contributions By Lobbyists On Real Estate
Issues Ye Jevelopment
o: 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.
(/es—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 SHAL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signatu 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 each City Code d all-re ng equirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID U&K
Form of Identification Form of Identification
Personally known(Lobbyist) Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
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State of Florida,County of Miami-Dade tate of Florida,County of Miami-Dade
SOFlA TERRAZAS I
Sworn to and subscribe�Lb h�f��r�e me ,;' `r •s worn d subscrib a re me
This day of �dV�- ,2011 .: MY COMMISSION#FF 105996 his da of ,201
• �a= EXPIRES:March 25,2018
' .•� Bonded Thru Notary Public Undomr:tcrs
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Signatur P lic of –St of Florida Signature of ai o a –State of Florida Notarization f Lobby st's signature Notarization of incival's signature
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TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid �==, iV
Lobbyist Registration Form received and verified by: rn
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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 CilyClerkC@miomibeachfl.gov
Tel:305.673.741 1 ,Fax:305.673.7254
LOBBYIST NAME: �.Ao
I understand-that Ito-later- F=ebryM 28 of-each-; F must file-the foHowing-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 30th of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
Signature: Date: C;
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FACLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc