Barbara M. Goicoechea - Dura Sports SA VCOA
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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 specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST: (Last) (First) (M.I)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
3D S - 538—73$0,q �iCb= S3FI - sn 41f �2.A�� ACT OA35•car►
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone,or e-mail address.
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAUCLIENT:
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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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: P-(C
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: a 1 -b J e ('O r ,010
APE01a=IC LOBBY ISSUE:
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Issue to be lobbied(Describe in detail):
nl.CITY,I�IGIENGIESlI.ND1V1 UAL TO BE:LA��IED:
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 general nature of the subject contractual relationship.
Sec 2482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
tMe of person to be lobbied
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Pursuant to City Code Section 241,82(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 °�
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) NO (:10
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): CD�''[�(��.�►'C-101J
(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 Youlobbyinci on a present or pending bid for goods equipment or services,or on a present or pending
award for ao ds 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 VNo: Are you lobbyina on a pendina 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 Mao?.
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 VNo 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 STATEME
OATH LISTING LOBBYING EXPENDITURES AS WELL AS COMPENSATION RECEIVED,IN THE CITY OF MIAMI E
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPEN 4VI /
COMPENSATION DURING THE REPORTING PERIOD. j
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Signature of L&byist n 0
I do solemnly swear that all of the foregoing facts are true and correct and that I ave read or am familiar with the provisio
in Section 2-482 of the Miami Be h City de and all reporting requ' ments.
Signature of Lobbyist
Signature of Principal/Client: y 61VII
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VI PRINCIPAL IDENTIFICATION:
. LOBBYIST IDENTIFICATION:
_Produced ID ��\\11111111111/i/��/ Produced ID ���\11110111111I1//��
Form of Identification \\a��S S G.A /Zj
N // Form of Identification \ova\ �c�G.A%
e O� t 2 A'. /personally n Princi al ;Personally known(Lobbyist) �O Abe 6,?0 9 s know ( p ) ` et 28,20 9
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VII. SIGNATURE AND STAMP OF NOTAR&* •• :*= *: •
2� • #EE 107208 :Q� ZZ% #EE 107208 Q�
State of Florida,County of Miami-Dade ��►: �� State of Florida,County of Miami-Dade 0p� p`
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' + �i►dedm :pQ� Sworn d subscribe d befo a me ,y n► �.
Swom to and subscri6ec�before me /�9/.°•-�%j�� ;: `�� �� 4f 201 ��s •' ►i8d%0. Q,��•�
iUa,�P,.-�a/201� i/ A '•.....•• mac' This'1 day of 0 / A •° .• N
is day of _ /�C/
/ C,STA��� //// 111161111101 `\
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ig ature of Public Notary—Stat f Florida n ture of Public Notary"of rization of Lobbyists sig ture rization of Principa
TO BE COMPLETED BY TY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ No Amount Paid S MCR 0 Date Pald
Lobbyist Registration Form recelved and verified by: °� �- 01/22/2014 ReAsed
F;\CLER.\$ALIL\tlFORfc4S\LOBDYtS'FORr�4SlLabhyitt Annual Re�#str3tinii Form'doc
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11�� A A B C H
city.of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rofoel E.Granado,City Clerk CityClerk @miamibeachfl.gov
Tel:305.673.7411 ,Fax:305.673.7254
LOBBYIST NAME: '�A�A a 1 CoeG(
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 FORMA
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$50.00 a day shall be assessed for all
Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal)
to file the Statement or pay the assessed fines-after notification.
Any lobbyist,who fails to file the required Statement by April 801'of each year,shall be
automatically suspended from lobbying until all fines are paid,unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
W Dat
FACLERI$ WaFORMSILOBBYIST FORM I-obbyist Registration Form.doc
ility of W ami BeaCh-Florida
Finalre Department
1 City hall
1431120-1 11/07/2014 8R1 T130
Fri liev07,2014 12:49Pti T ran5#8-8
8 $350.00 HCRCLFRK ._ MCR-City Clerk
KR#: 37077
i ITCM(u): TOTAL: $350.00
Check (121352) PAID $350.00
Have a nice day!
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III ellaneous Cash Receipt ` $ i, rk E ry °",350,00
CITY OF MIAMI BELCH
'370 7
No. r
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Cash 0 Credit-Card 2'Check# `" .
$ .
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Received of
Address
For .' f
(THIS INFORMATION MUST BE COMPLETED) Office of Finance Director
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Preparer. Dept: ! :, SO -EXT: r