Daniel G. Ciraldo - MDPL 825 Michigan Ave. City of Miami.Beach.Office of the City Clerk
1700 Convention Center Drive Miami Bead FL 33139 d c44
LOBBYIST REOISMADON FORM V�-
Lobbyist meant all persons employed or retained,whether paid or not by a principal who seeks 1b encourage the fie.defeat or
modification of any ordinance, resohgk n, action or decision of any commissioner; any ac*m, de�ion, recommendation of the City
Manager or arty city board-or commitl es;or any action.decision or recommendation of any city personnel during the time period of the
-enft-decision-making.pros-on-such-action,•decision-or -that foreseeably will be-heard or-reviewed-by the-city
commisslon,or a city board-or committee.. The term fly includes the principal as well as any employee engaged In lobbying
acdvWm& The term"Lobbyists"has specific exclusions. Please refer to Ordinance
NAME OF LOBBYIST: (Last) (M•n
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BUSINESS _aW ,_ (CRA .
TELEPHONE NUMBED FAX NUMBER: EMAIL-
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1. LOBBYIST RETANW BY:
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NAME OF PWNGPAUCLIENT: � i �;
o M^� Y`��y► V
BUSINESS NAME AND ADDRESS pVdrnb� p Code) --
TELEPHONE NUMBER. < FAX NUMBER(Optional). EMMAIL(Optionai)
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OR
Fq1;oat.t6ls esaian iif prindpal is a Corporation,Pim WAwar'hRA(Secd=2482(41
• NAME OF CHIEF OFFICER.PARTNER,OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY.A 5%OR MORE OWNERSHIP,INTEREST IN SUCH CORPORATION,
ir PAF414ERSHW OR TRUST:
PAP -� �� � ��-� •- — � �r ���
Issue to be pasaft In detail):
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1/tbD any . std cam
.. "a .. lssim r or p *on.12 momhs prscedlog mach persaWs
conmummima of servi"VAM the qfty W-the pmwt daft stftw tM onoral ndwe ofilwaWME
7-48Zia y FWt t tae of f arW Cartrad uafi lup(fin) I YES NO
title o! tg w lobbied=
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Purav�ant to Clay Code SecSon 2 (9)try.agiat nt shay be Wired Iz-fe:d ixu t:of ow bps, ulonal
rclati _ar oUser-dip rise to an appemnoe of an gnproprge�y,wuh any quart city comm�sioner cry peRaraml certro
:aught 15o tie fain sd m i oti tlre.lobbyM N form tifsd. Is
Sec.2 F er Prsit.
FaCLERt ALL1aFORMMLOBBYIST FORMSU obbylst RegMiMan Fonn.doc
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
eta �--fia �,
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): r/ot�
(REQUIRED).
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 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 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes-No: Are you lobbying on a Pending a22lication for a Development Agreement with the Cily or ap2lication 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 SHALL BE FILED EVEN IF THERE 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 Miami Bea City Code and all report g r uirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
M
Produced ID co Produced I aw.
Form of Identification w 3 lentifcati RITE
$ s Notary Public-State of Florida
m ' My Comm.Expires Nov 21,2016
Personally known(Lobbyist) z Personally ipaliommission#EE 220927
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VII. SIGNATURE AND STAMP OF NOTARY:
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State of Florida,County of Miami-Dade x State of Florida,County of Miami-Dade
Sworn t9 an ubscribe b fo me W wom and subscn me
This �_ ay of 201 •, , � his�da 201
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/
Signature of Public
Signature of Public Nota —Sta a of Florida � . . otary—State of Florida C
Notarization of Lobbyist's signature otarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY v/ 1
Annual Registration fee:' [ ]Yes[ .]No _Amount.Paid-$- MICR# Date_Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual-Registration Form.doc Revised 01/22/2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.d
ERIN E HEND
..; RI1(
MY COMMISSION#EE858128 153 EXPIRES Februa
(40? rY 03,2015
Mmed=.Mm
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M I AM I BEAC H
City of Miami Beach, 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
LOBBYIST NAME: 0"'d C 4XI
I understand that no later than February 28 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 2-465 (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 2-455.1, 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.
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Signa ure: Date:
FACLERULUaFORMSILOBBYIST FORMS\Lobbyist Registration Form.doc