Caitlin E. Wood - Aqua Foundation �j
MIAMI BEACH V 6�
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 M0;T fcclusions. Please refer to Ordinance 2004-3435
`I 't 11, C
NAME OF LOBBYIST: (Last) N (First) (M.1)
M 0 A YQ )VkA A,fi oyn
BUS ESS NAME AND ADDRESS (Number and Street) City) (State (Zip Code) •:?;-3 I
2 Z r a (VI
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
A
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAI ED BY:0-A C--V u Vo A+? &V C,
NAME OF PRINCIPAU LIENT:
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c]
• 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: N
u
PEP-,f 'C;' .OBBY;ISSUE ��► -t
Issue to be lobbied(Describe in detail):
ul CITYAGENGFES/INDIVIDUALS�FTO BE`LOBBIED::
�.!.R...•;f.wl'd'...,tlw_.. e s sFY--.x'A!iL t`.}a..r. 1 t'.Sei.•�r..:,.."-sui..i C 14'.;.1.'unv.l..• .e[..}
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
title 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 Professional Relationship
Y
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
i
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). V
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_ 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.
s 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 IAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL.—BE FILED EVEN IF THERE HAVE BEEN NO aPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD. (j
Signatu obbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have ea or am familiar with the provisions contained
in Section 2-482 of the Miami Be City Code an II reporti quir ments.
Signature of Lobbyist: J 14A
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
►Q
Produced ID Produced IDS , ci
co qc Form of Identification w Form of Identification o N
U mo i .3 —
Q .► a+
Personally known(Lobbyist) y W o Personally known(Principal) � W?
VII a. SIGNATURE AND STAMP OF NOTARY: °' 2 � ° y ` c :T
� `
Q _r a
'co a
State of Florida,County of Miami-Dade o� a a State of Florida,County of Miami-Dade E E
Sworn to and ubscribe bef re me a �, b Sworn and subscribe before me o b
This d of �- ,201 ,,,,,, w This day of 201 z ,,v a
o
m
•
Si nature ublic No —State of Florida Signature o u lic Notary to of Florida
G *`" ` Notarization o Principal's signature =a
Notarizatio of Lobbyist's signature "'-
TO BE COMPLE Y CITY CLERK'S STAFF ONLY
Annual Registration fee: [' ]Yes[ ]No Amount Paid$ 41 MCR#
- - - .-. / Date Paid. _ I-'E
Lobbyist Registration Form received and verified by:. _
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc a ed 01/22/2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
.................... ...............-- ....... ................... ................
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City of Mic'mi Beach,1700 Convention'eitler PHve,Mlornt Beads,F'1,>iea 33139, �rw.r�Eans?$ec chr.�rw
CITY CLERV Of;ice
Rofae!E.Granado,C.iiy Cle;k C;iyCl�,k r�lomiaevcl;fl. o�
Tel:305,673.7411',Fax:305.613.72-d
LOBBYIST NAME:
I
1 understand that no later than February 28 of each year, I must file the following form,
pursuant to Section 2-485 of the Miami Beach City Code,with the City Clerk's Office for
ail.active lobbying issue$.
`f) 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 can Ethics and for code violation evaluation.
In addition, once an'issub I have recgistered t�r'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 2-435(d),the.City Clerk shall notify any lobbyist(or principal)who
falls to timely file a Statement and..in.addition to any other penalties which_may be
unposed as provided In Section 2-485.1,a fine of$50.00 a clay shall be assessed for all
Statement(s) filed after the. due date. The City Clerk shall notify the Miami-Dade
County.Commission on Ethics and Public Trust of the failure of a lobbyist(or principal)
to file the Statement or pay the assessed fines after notification.
Any lobbyist,who fails to file.the required Statement by April 301 of each year,shall be
automatically suspended from lobbying:untii all fines'are paid, unless the fine has been
appe I d to the Miami-Dade County Co mission on Ethics and Public Trust.
Signature: Date:
FACLFR1$ALLIaF0RMS\L0BBYIST FOWSILobby st Registration l=omi:doc
I
Prieto, Silvia
From: Caitlin Wood <caitlin @aquafoundation.org>
Sent: Wednesday, November 12, 2014 3:12 PM
To: Prieto, Silvia
Subject: Re: Read: Lobbyist Registration
Attachments: aquafdnmiamibeachlobbyingform.pdf
I just sent it again via the secure site. Isere it is , just in case.
Thanks!
On Wed, Nov 12, 2014 at 3:05 PM, Prieto, Silvia<SilviaPrietogmiamibeachfl. ov>wrote:
Unable to open the file
Silvia Prieto, Administrative Aide I
CITY CLERK'S OFFICE
1700 Convention Center Drive, Miami Beach, FL 33139
Phone: 305-673-7000 ext. 6269/ Fax: 305-673-7254
' www.miamibeachfl.gov
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,
tropical, historic community.
-----Original Message-----
From: caitlin@aquafoundation.org [mailto:caitlin@ aquafoundation.org]
Sent: Wednesday,November 12, 2014 2:50 PM
To: Prieto, Silvia
Subject: Read: Lobbyist Registration
Your message:
To: caitlingaquafoundation.org
From: silviaprieto o,miamibeachfl.gov
Subject: Lobbyist Registration
Sent: Wed, 12 Nov 2014 07:22:51 PM GMT
Message ID: l_cl9942bd00000149a57554dbff63adff312b7501 @localhost
was displayed on Wed, 12 Nov 2014 07:49:38 PM GMT.
Caitlin Wood, Executive Director
Aqua Foundation for Women
Leading. Building. Transforming.
ca.itliil(a)aq afoundatioil.or 305.576.2782
i
Prieto, Silvia
From: 'caitlin @aquafoundation.org' <caitlin @aquafoundation.org>
Sent: Wednesday, November 12, 2014 3:11 PM
To: Prieto, Silvia
Subject: RE: Lobbyist Registration
Attachments: aquafdnmiamibeachlobbyingform.pdf
Please see attached. Let me know if you have any problems.
Thank you so much.
------------Original Message:
FROM: "Prieto,Silvia" <SilviaPrieto@miamibeachfl.,gov>
TO: "'caitlin @aquafoundation.org"' <caitlin@aguafoundation.org>
DATE: November 12, 2014 7:22:49 PM GMT
SUBJECT: Lobbyist Registration
Dear Ms.Wood,
The attached Form was left black on your Lobbyist application, please complete and send it back to me.
Thank you,
(image)
Silvia Prieto,Administrative Aide I
CITY CLERK'S OFFICE
1700 Convention Center Drive, Miami Beach, FL 33139
Phone: 305-673-7000 ext. 6269/ Fax: 305-673-7254 www.miamibeachfl.gov(link:
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ocked::blocked::blocked::blocked::blocked::BLOCKED::B LOCKED::BLOCKED::blocked::blocked::BLOCKED::BLOCKED::BLOC
KED::BLOCKED::http://www.miamibeachfi.gov/)
all who live work and la in our vibrant tropical,
We are committed to providing excellent public service and safety to a o p ,
p g p Y play
historic community.
1
I
Prieto, Silvia
From: Prieto, Silvia
Sent: Wednesday, November 12, 2014 2:22 PM
To: 'caitlin @aquafoundation.org'
Subject: [SEND SECURE] Lobbyist Registration
Dear Ms. Wood,
The attached Form was left black on your Lobbyist application, please complete and send it back to me.
Thank you,
WM
mom 400001010000AMM
Silvia Prieto,Administrative Aide I
CITY CLERK'S OFFICE
1700 Convention Center Drive,Miami Beach,FL 33139
Phone: 305-673-7000 ext.6269/ Fax:305-673-7254
www.miamibeachfl.qov
We are committed to providing excellent public service and safety to all who live, work and play in our vibrant,tropical,historic community.
1