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ty of Miami Beach Office of the City Clerk �� tU A
1700 Convention Center Drive, Miami Beach, FL 33139 0 p,
LOBBYIST REGISTRATION FORM Cr O
Lobbyist means at 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 "Lobbyis ." has specific exclusions. Please refer to Ordinance 2004-3435.
kagal •NAME OF LOBBYIST: (Last) (First) (M.I)
irtS i1'1) %oc.i�CS �4- qo� Li.-k col e, �. S4- z4
BUSINESS NAME AND ADDRESS
(Number and Street) (City) (State) • (Zia Code)
-S Co 2r -12 (State), ., F� �, 3t3�
ELEPHON NUMBER: v .._tr-S �►J L/ _ I.Cn(1f1
FAX NUMBER: E' AIL:
Please notify this office if your contact information changes address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
puCC U
NAME OF PRINCIPAL/CLIENT:
/°g ,--Tur - - C /92c /V 12 Si--_ 5,4e. 31) i ,` L - 1 Z
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip ode)
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:
See 4 �ra(1 -�c
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%QR MORE OWNERSHIP INTEREST IN SUCH CORPORATION.
PARTNERSHIP OR TRUST: _. Otte ci. l Q-L-- i ;(.
IL SPECIFIC LOBBY ISSUE: t—�A- hCC �4S - '4���°�s `t ProVt JJ CLe.
�-e‹ devl-h.q-\ r �reia.-( U3��ke.. alt o�S c� i �r g,:1
Issue to be lobbied(Describe in detail): S
Ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
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 cit to the .resent date,statin. the•eneral nature of the sub'ect contractual relationshi..
Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to be lobbied
CopArti 4ee lerrn eft . r-anC,h;�
Wa ri rs
/.
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(g)Any Financial, Familial or Professional Relationship }
/I . - ri 1 _.
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F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.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) art-I —
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(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
_
_Yes No: Are You Iobb in. on a •resent or •endin• bid for•oods e•ui•mentor services or on a •resent or sending
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 ou Iobb in. on a sendin• a••Iication for a Develo•ment A•reement with the Ci or a•glication for
chan.e of zonin. ma. designation or chan.a to the Ci 's Future Land Use Ma.?
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.
Yes1/No: Are ou rearesentin• a not-for-.rofit corporation or enti without special corn sensation 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. 1
ignature of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and that have read or am familiar with the provisions contained
in Section 2-482 of the M�i B-ch City Code and all r ;-- requirements.
Signature of Lobbyist: /j%I . j
Signature of Principal/C lent: __,,/J- '� ;
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID ✓ roduced ID F 602, "733 52-0b0"0
Form of Identification Form of Identification
ersonally known (Lobbyist) _Pe rsoliiilhillidimigiiillfil°°"— — — —
VII. SIGNATURE AND STAMP OF NOT< '_ i 4 = - MAN BEAUCHAMP
......, ,- 9 \ Notate Public-State of Florida
\ , I.SANCHEZ
State of Florida County of Miami-Dade =*; '•_' ;* MY COMMISSION#EE204254Sta 9 of Fl4-i is v,'�':'o �:� �glres May 5,2018 )
y , - loud
Sworn to And subscribed before me %`-. EXPIRES:June 3,2016 �\A,�;' �� iron S FF 119190
• �,, d ;�:•` BondedThruNotary PublicUnderwritttrI ,n andzubu:' befor i
This 21' , d:y of A ,201 ,p„; . . .. ._'. • cpru,�
/ , / '
Signature of Public Notary—Sr::te of Florida Sig ature of Public otary—State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY 6/3 t,
Annual Registration fee:.[ ]Yes[ ]No Amount Paid$ 35"& MCR# 3.3 Da - Paid • - •
Lobbyist Registration Form received and verified by • 1 • ' i .
F:\€LsR\SALL\.s'ORMS\LOBTITST FORMS\} b°is t Annual >e, tic n Forrn.doc I ' Revised 11/18/2013
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
Camm, Patrick
From: Carom, Patrick
Sent: Friday, April 17, 2015 3:04 PM
To: 'Matt Peters'
Subject: RE: Lobbyist Registration Form
Thank you,
I will update your information and attach this email to your folder.
Regards,
COW MICOMMINOMMIEMJICIIIIMI=IMMINIM
own OISMNIIIIIIMMINMASIM
1q15•
PV)['NO[BE AC
Patrick Camm,Administrative Aide I
OFFICE OF THE CITY CLERK
1700 Convention Center Drive, Miami Beach, FL 33139
Tel: 305-673-7411/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.
From: Matt Peters [mailto:MattPsrlawfirm.com]
Sent: Friday, April 17, 2015 2:43 PM
To: Camm, Patrick
Subject: RE: Lobbyist Registration Form
Hi Patrick,
Thank you for reaching out to me. With respect to Section 2-482 (c), Rudy Bustamante is the 100%owner of"1-866-
Junk Be Gone".
This case ended last year. MY withdrawal from the case should be effective December 31, 2014.
Thank you.
Matt Peters, Esq.
Stratton, Feinstein &Associates, P.A.
407 Lincoln Road, Suite 2A
Miami Beach, Florida 33139
Phone: (305) 672-7772
Fax: (305) 672-1038
1
From: Camm, Patrick [mailto:PatrickCamm@miamibeachfl.gov]
Sent: Friday, April 17, 2015 11:50 AM
To: Matt Peters
Subject: Lobbyist Registration Form
Good morning,
We spoke on the phone a little ago about missing information on the above form.Could you please provide me the
information for Section 2-482(C)and send me an email.
*If this case ended last year,you can request to withdraw as of December 31, 2014,to prevent having to file this form
next year.
Regards,
ors ,fir.
Patrick Camm,Administrative Aide I
OFFICE OF THE CITY CLERK
1700 Convention Center Drive, Miami Beach, FL 33139
Tel: 305-673-7411/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.
2
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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: r 3
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 2-485 (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 30th 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.
,- • 2_at 1 z_c,
ignature: Date:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 5-22-14.doc
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