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Anthony L. Recio - Baptist Health South Florida, Inc. MIS . City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 a4): `o) LOBBYIST REGISTRATION FORM � L 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. Recio Anthony L. NAME OF LOBBYIST: (Last) (First) (M.I) Weiss Serota Helfman Cole & Bierman, P.L., 2525 Ponce de Leon Blvd., Suite 700, Coral Gables, FL 33134 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 854-0800 (305) 854-2323 MBierman@wsh--law.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify:this:office If your.:coritect:inhordnlatfora:.changes::.adds ess:;ph one, or e.=r ilia address::: : f. LOBBYIST RETAINED BY: Baptist Health South Florida, Inc. NtigE 5p Redl $ AdJCLIENT: 6855 Red Road, Suite 600 Coral Gables, FL 33134 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)786-662-7334 . TRecio@wsh-law.com ) 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: 6r'4A E, keel,/ . Pre stcQent 4. C.ED o 1 • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CO PORATION, PARTNERSHIP OR TRUST: MT for PcoEe+-��a c,�y T--3 .TJ Hospital District Cc::142 Ld ' issue to be lobbied(Describe in detail): > ' III. "+ r�� -^, _f � r�:� } c'� 1 "/x E" ` r :: _ Pursuant to City Code Section 2-482(a)(4)include the commissioner or personnel sought to be lobbied,and whether the IobbyisYtias 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 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO title of person to be lobbied City Commission and Staff „1/. p z Q x "� x 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 flied. Sec 2-482(g)Any Financial,Familial or Professional Relationship None F:ICLER\$ALLIaFORIUISILOBBYIST FORMSiLobbyist Registration Form.doc t IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $575.00/hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $575.00/hour (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 xNo: Are you lobbying on a present or pending bid forsaoods,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 xNo: Are you Iobbyina on a pending aoollcatlon 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, lo: 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 Anthony L. Recio 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 Beach City Code and : =Fortin! requirements. • Signature of Lobbyist: Anthony L. Recio 4 Signature of Principal/Client: .. 'Y- VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID _Produced ID Form of Identification Form of Identification _" Personal) known(Lobbyist) _/Personal) known(Principal) ) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida,County of Miami-Dade State of Florida,County of Miami-Dade Sworn tr :nd subscri•=• •:fo me rn and subscribed before me This day of �'G1 , 0 (' Is /) day of • - Fr . ` •""" " ., HILDA R.PORTAL �,f,' .•» � V. --� it.S Notary Public-State of Florida 6 Signature sf filiWP S' ature of Public tiotary 47, ti. .da Commission•FF 195137 Notarizatio b 1611 llC ,2015 Notarization of Princ sal': : Y My Comm.Expires Feb 2,2019 • 440F Fo• Bonded Budget Fbkery Swims is' Bonded through*Donal Notary Assn. TO BE COMPLETED BY CITY CLERK'S STAFF • LY — • Annual: ist tion.fee: Yes. ..... :AIsa:::: lmount:Pald: :;:; :. Ost ?MCR:#. :::: .::':'.:. :.:::°:::;::::p. .:::::�,: a nd. .L bb s-�I�e istr tip :F rrn:. celxed a v d ed.b ... ...- sorm.d.k.:..:.::::::::::.: :::::::::::::::::::::::::::.:;.:.:::.:::::::::: ::.: .:.::: f:1ClER1$ALL1a�0itM5�l.QBBYLST�F4RMS 1�-obbyist�0.nnual:RBgistratl� � _ • F:ICLERI$ALL1aFORMSILOBBYIST FORMS\Lobbyist Registration Form.doc :, . . ..... MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachf.gov CITY CLERK Office Rafael E.Granada,City Clerk CityClerk @miamibeachfl.gov Tel:305.673.7411 ,Fax:305.673.7254 LOBBYIST NAME: Anthony L. Recio 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 EXPENbITURE 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 falls to timely file a Statement and in addition to any other penalties which may be imposed as provided in Section 2-486.1, a fine of$50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist,who fails to file the required Statement by April 30th of each year, shall be automatically suspended from lobbying until all fines are paid,unless the fine has been appealed to the MI i-Dade County Commission on Ethics and Public Trust. 3/7 ly Signature: Anthony L. Recio D te: F:ICLERI$ALL1aFORMSILOBBYIST FORMSILobbyist Registration Form.doc • f j, 4.,�fm! 5 d £afi�fr',di...0 ui3Z 13 , Miscellaneous-' ' ' '' . . Cash Receipt plr'':=r i E l k r1` u 04,i�� -1 1 t . :: = -� � y ci` ` CITY OF MIAMI BEACH ei.2.,:risi-,-:-.:,,,,..!-.-t..: .Y 1 I 7 / 4 N 1 1.�: lr _ :. �io . 0 Cash: 0 Credit Card 'Check# .. : ::1 $ .'. Arlslress ., Four . ''o ,.5 )f. r .s.. ' , . (THIS INFORMATION MUST EE• ,1,,.• . ':-' ,' ' ,..::::::1-' ',,.:.,r..'‘ .-. ®SEC @'of Finance ,?".:,.,..,,, ,' ... _, , .„ ..,-, ,...B3;;I:-;7t1 :.• . ' : : . ' ' ' .', ),;:, :.,i .:'..1 y,t, 4 Account Number: O 1 ::,. w;;�'CI.Y,(<-• �, :. = Pry �r @r: .:; ,: ��-�� r'� # '��.t� � { f -_ �. � R t Dept , EXT ,'� y/ • 'f J'r + 1 ' 1 • vgasegsmaaangsnonaumr , City ance D of Mmi beach-Florida n Finepartmia et 1 City Hall 1506020-1 03/1012015 BRi T131 Tue Mar10,2015 11:03AM Trans#17-17 , l 17 $350.00 MCRCLERK - MCR- ,y Clerk ; * MCR#: 402751 1 ITEM(3): TOTAL: $350,00 Check (200106) PAID $350.00 Have a nice day! •