Daniel G. Ciraldo - MDPL 5005 Collins Ave. MIAMIBEACH
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City of Miami-Beach.Office of the-City Clerk (JD
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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 tern"Lobbyists"has specific exclusions. Please refer to Ordinance 2004-3435
(,vim 161&2 1)C.11�
NAME OF LOBBYIST: (Last) (First)
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BUSINESS-N BUSINESS-NAIME ANDM DRESS (Number and Street) (City)- ( e) (Zip Coda)
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notJfy this office If your contact Information changes:address,phone,or e-mail address.
1. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAL/CLIENT: PC) NINO
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BUSINESS NAME AND ADDRESS (Number and Stteet) (City) .(Slate) (Zip Code)
TELEPHONE NUMBER. FAX NUMBER:(Optional) EMAIL:(Optional) 140
Fill out thine section-if principal.Is a.Corporation,Par-tnershlp-or Trust[Section 2482(Q.
• 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:
I
ll.SP CIFIC LOBBY SS E:
sobs &/4kg ��
Issue to be lobbied(Describe in detail):
III.CCMA"NCIESAND OUALS TO BE LOBBIED:
Pursuant to City Code Section 2-02(a)(4)include the commissioner or personnel sought to be 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 eneral nature of the subject contractual relationship.
Sec 7-482(a)(4)Full Name of Individual"and' Contractual Relationship(Explain) YES NO
tide of pemon 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 Any Flnanciall Fam.111 411 or Professional Raktimship
FXLERULLWORMSILOBBYIST FORMS1Lobbylst Registration Form.doc
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DI C OSE WHETH R HOURLY,FLAT RAT OR OTHER):A) LOBBYIST DISCLOSURE:(Required) YA T
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST C MPENSATION):
(REQUIRED). n1a
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 VNo: Are you lobbying on a present or pending bid for c
ioods,equipment or services or on a present or pending
award for woods,equipment or service?
2) Pursuant to Miami Beach City Code Section 2490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
evelopment Issues':
_Yes I 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 2482(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_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
-OAT-H.-LISTING LOBBYING-EXPENDITURES.AS WELL AS-COMPENSATION-RECEIVED.-FN -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 a 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 Be City C de and all-reportin eq rements.
Signature of Lobbyist:
Signature of Principal/Client-
V1. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID 46606-
Form of Identification Form of Identification
Personally known(Lobbyist) Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida,County of Miami-Dade Who, ate of Florida,County of Miami-Dade
•' ti, SOFIA TERRAZAS orn a d subscri befo a me
Sworn to nd subscribed bef re me �;� MY COMMISSION I FF 105996
This � day of ,201 :, EXPIRES:March 25,2018 is d y o , 201y
Bonded Thru Notary Public Underwriters
Signatur P lic No pry- to of Florida Signature of 31%i-al'stignature
tat of orida
Notarizat n Lobbyist's signature Notarization
TO BE.COMPLPETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [: .]'Yes[, j No. Amount Paid
%—.6—MC # ��' Date Pai
Lobbyist Registration Form received and'verified by:
F:'CLEI'd.y$� LLkaF®RMiSXLOB LOBBYIST F3?t;i gwobbr ist Ann egistration Form Revised 01/22/2014
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City of Miami Heath, 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
LOBBYIST NAME: 0 a,^.,q C r-0.
I understand that no later th>rarr February 28 of each , 1- must fide 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 EWcs-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 30t'of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appeals to the Miami-Dade County Commission on Ethics and Public Trust.
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Signature: Date:
FACLERULUaFORMSILOBBYIST FORMS1obbyist Registration Form.doc