Daniel G. Ciraldo - MDPL 530 Lincoln Rd. • City. of Miami.6.each.Office of the-City Cleric
1700 Convention Center Drive, Miami Bead FL 33139 5-3o ''�'�Ln
LOBBYW REOI MAnON FORM 7 Q
Lobbyist means all persons employed or retard,whether paid or not,by a principal who seeks to encourage the image,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 r�eccmmendation of any city personnel during the time period of the
entire_detision4naking.process-on-such-aeon,-decision-or -that fbmsesably vAN-be,t*wW-or-reviewed by the-city
commission,or a city board-or committee. The tern spy includes the principal as well as any employee engaged In lobbying
activities. The term"LobbylsW has specific exclusions. Please refer to Ordinance M"43k
CU.a I A2 . &",'d
NAME OF LOBBYIST: (Last) (First) (M•t)
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BUST EM- . wid-Stredl (City).
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TELEPHONE NUMBED FAX NUMBER: EMAIL
Phowilo /fliDfll CAS j1DS#Ifi..ohm V BfSi AQ�'1te'i Oil<@�/l1� 55. ;
1. LOBBYIST R ETAMW BY:
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NAME OF PRINCIPALICL LENT: of ED
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BUSINESS NAME AND AMRESS .94drok arm (City) . (State) C
TEI.�HOME NUMB FAX
NUS(Optional). 'BAL-(Opda"
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LOR
F'iti- .tlrls simian f Lk aCourparorTicuM[SeOn2482(c)]
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERS'w MTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
IL, � Ww" Ur
Issuetb be bbbied'(D in detat*
Punwwdt6Ck y t'rOdQ t on Z A]i IriCltidd*e Ol"pf 501rrI iOUSM I be f ed,wW 1Yr�the 1�ylit hm samied
°°! 'or+ 1.w1 sold dtt►comrnlsldoner or P from..i2 nmornhs prsceding loch persoN�s
co+rrrrranoeme of iewlae with& _th'itie the nature ofthe- -ooe
Sec 2-d(e��'Lj Fufi Nbnre of°fndlirkkud and Contras u Re onshlp(waif,) .YES NO
tide o�peraw>Do-be lobbled=
Pursuant to 01W Code:ftcdon 24 (g)Crvery.Kptsttrant'sha8 be too at d the extent of wry iarnial ar
'! !dP SWIng rise to an appe�noe of an Irnpropriaty.wNh aey drrr�srrt city eamm or city pet3orarel who Is
sought�a tie lo6blsd as�idlied on ttra obbyiM rpm Corm fi'�d,
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FACLER1 ALWFORMSILOBBYaST FORMS1Lbbby)st'Registration Fonn.doc -
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) i t,
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). 0
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Issues":
_Yes No: Are you lobbylng 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 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
evelopment Issues":
_Yes_ 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.
.V/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 SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD. (4
Signature of Lobbyist
I do solemnly swear that all of he foregoing facts are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miam• ach City Code and all repo requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDEN I
:2 . , NINA W7of
_Produced ID : . Produced ID -Sida
• •..
Form of Identification .OS,���' ,refidRl�lt.Expires Nov 21,2016
/ #111 \��..r Commission#�EE 22092 7
/Personally known(Lobbyist) �/ Personally kn ... .
A
VII. SIGNATURE AND STAMP OF NOTARY: 7D j ;0
LE 2
State of Florida,County of Miami-Dade g State of Florida,County of Miami-Dade
Sworn to Wd subscribed be re me Sworn and subscri d re me
This ay of 1 ® � C This/ d y f ,2011
w rn
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CD
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Signature of Public Notary–State of Florida Sig Katb re o Pub ary–State of Flori / G
Notarization of Lobbyists signature a Notarization of Principals signa re �l
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY V
Annual Registration fee: [ ]Yes[. ]No Amount Paid$ MCR# Date Paid
Lobbyist Registration Form received and verified by: -
F:\CLER.\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual:Registration Form.doc Revised 01/ /2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E.Granado,City Clerk CityClerk @miamibeachfl.gov
Tel:305.673.7411 , Fax:305.673.7254
LOBBYIST NAME: D_Ia�o -GrV-4
understand that no later than February 23 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$50.00 a day shall be assessed for all
Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal)
to file the Statement or pay the assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30'of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust
0--1 1 61
Signature: Date:
F:ICLERI$ALL1aF0RMSIL0BBYIST FORMS\Lobbyist Registration Form.doc