Daniel G. Ciraldo - MDPL 4041 Collins Ave.r Ag AAIAM l 'b"I'EACH.
O I
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
NAME OF LOBBYIST: (Last) (First) (M.I)
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BUSINESS-NAME ANDM DRESS. (Number and Street) (City). ( e) (2;p,Code)-
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TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please:noWy1his office H your contac!`lnfortnation crtanges address,phone,or e-mail address
1. LOBBYIST RETAINED BY:
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NAME OF PRINCIPALICLIENT: .��QnM
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BUSINESS NAME AND ADDRESS (Number and Sleet) (Clty) jState) Zip Code)
TELEPHONE NUMBER FAX NUMBER:(Optional) EMAIL:(Optional)
Fill.out_this..section.if.principal.is.a.Cor-poration,_Partnership-or.Trust .section-2-482(c)l
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY:
1
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A S%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
II SPEGl 1C.# . Bed"
Issue to be lobbied(Describe in detail):
' III
city'+ ► ".t'?i 00
Pursuant to city Code Section 2482(a)(4).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 in
preced g such person's
commencement of service with the city to the present date stating the eneral nature of the subject contractual relationship.
Sec Z-M(a)(4)'Fult Name of Indhddual-and C'ontractuaf Relationship(Explain) YES NO
title of person to be lobbied
' Pursuant to City Code Section 2-482(g)Every registrant shell 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 flied.
Sec 2 Any Ej rtulal Ea. iliail Ps> esslonal Rsbazlon
jill] gill
F:ICLERI$ALL1aF0RMSIL08BYIST FORMS\Lobbyist Registration Form.doc
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCL S W.I THE R HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) _
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). O1'�
The following information-must be answered:
1) Pursuant to Miami Beach City Code Section 2488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Issues":
_Yes o: 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
'Development Issues":
_Ye 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.
JYes—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 T-+tE-CITY-OF MIAMI-BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THE E HAVE BEEN 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 i Bea h City Code a d-all"re ing requirements.
Signature of Lobbyist: M/�, —
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 OF NO
SOFIA TERRAZAS
State of Florida,County of Miami-Dade := MY COMMISSION FF 105996 tate of Florida,County of Miami-Dade
Sworn t and subscribe be ore me =: :o; EXPIRES:March 26,2010 worn - d subscrib f re me
This _day f ,201 Bonded Thn,Notary Public Underur3ers I Of ,201t
•
Signature of bli otaryfStgtedVlorida Signatur o P is Not ry—St. e of Florida
Notarization L bvist's signature Notariza ' rinci al's signature
TO BE COMPLE ED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ . ]No. Amount Pa CR.# Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$AWaFORMS\LOBBYIST FORMS\Lobbyist Annua! A,Or, .a9 Revised 01/22/2014
F:\ LER\ ALL aF RM \L B YI T F ORMS\Lobbyist Registration Form.doc
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City of Miami Beath, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachf.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov
Tel:305.673.7411 ,Fax: 305.673.7254
s
LOBBYIST NAME: oen.,_o
understand-that no later than'February-28 of-each ear-, 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
-C unty 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
appe to the Miami-Da a Cou ty Commission on Ethics and Public Trust.
~ ! �)_ ~/
Signature: Date:
FACLERULWFORMSILOBBYIST FORMS\Lobbyist Registration Form.doc