Daniel G. Ciraldo - MDPL 1755 James Ave MIAMI BEACH
I
City f Miami Beach Office of the City Clerk V
ty ty
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
Lcal A Pr,.�t)
NAME OF LOBBYIST: (Last) -, (First) (M.I) '�'331
BUSINESS NAME AN DDRESS (Nurd6er and Street) (City) (St e) (Zip Code)
TA- %, 3 3 J,��l c� ,k
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY: YV OR
NAME OF PRINCIPAL/CLIENT: o� FL
BUSINESS NAME AND ADDRESS (Number and Street) V (City) .(State) (Zip Code)
TELEPHONE NUMBER: J _ FAX NUMBER: (Optional) EMAIL:(Optional) �\- (I v� j
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] ,
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY:
1/2 //�
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR M9RE OWNERSHIP INTEREST IN SUCH CORPORATION
PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY ISSUE: ,6" fi
v �o� kr S-� 7110
Issue to be lobbied(Describe in detail):
III.CITY AGENCIESIINDIVIDUALS 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 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 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
itle 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 Any Financial,Familial or Profeqsionall Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(D LO E 1AIHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) co-
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
I ues".
_Yes_No: Are you lobbyina on a present or pending bid for snoods,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
Development 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_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 SHAJM BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD. 4d 44"'It
Si ture Lof Lobbyis
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 2482 of the Miami Be City Co a and all-reporting equirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID i1ua@/�E
Form of Identification Form of Identification
$16—Personally known(Lobbyist) _Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida,County of Miami-Dade SOFIA TERRAZAS ate of Florida,County of Miami-Dade
Sworn to and subscrib f re me * . '+ MY COMMISSION#FF 105996 orn subscribe before me
This of ,201 �;= EXPIRES:March 25,2018 is d ,201
•�,Rd'hd:•` Bonded Thru Notary Public Undervinters a y
Sin ur f ubl' Not State of Florida Signature of Ulicholary4state,o Florida
No z n of obb i signature Notarization ci al' ignature
TO BE COMPLETR BY CITY CLERK'S STAFF ONLY
Annual Registration fee: { ..]Yes.[ ]No Amount Paid.$ MCR#. a Da'e.Paid
Lobbyist Registration Form receiVed and verified by; AW
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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:305.673.741 1 ,Fax: 305.673.7254
I
LOBBYIST NAME:
I- understand that no later-tharr FeebrjyML 29 of-each-year-, 1•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 I-or-principal)
to file the Statement or pay the assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 80"' 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.
Signa ure: Date:
FACLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc