Lili Bach - SEIU Local 32BJ Wor1AUS n'b
v-reAAA4-5 4.41.
NIG
iVa I AM 1 EA oitse5
vot 0 I
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.
Bach Lili
NAME OF LOBBYIST: (Last) (First) (M.I)
SEIU Local 32BJ One Flager Bldg. , 14 N.E. 1st Ave. , Suite 905, Miami, FL 33132
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-761-4663 305-672-9501 lbach @seiu32bj .org
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
SEIU Local 32BJ
NAME OF PRINCIPAUCLIENT:
25 West 18th Street, 5th Floor, New York, NY 10011
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
212-388-2175 dschmidt @seiu32bi .orq
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: N/A (we are a 501c5 Organization)
• IDENTIFY ALL PERSONS HOLDING DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: N/A
u SPECIFIC LOBBYISSUE: Workers' rights as it relates to living wages and
__. ..._.._- _,__... affordable health care.
Issue to be lobbied(Describe in detail):
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 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
Miami Beach City Commissioners Dede Weithorn,and Micky Steinberg Living wage and health care X
Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,familial, gr 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. e r-•
Sec 2-482(g)Any Financial,Familial or Professional Relationship NONE
'0 --
C.
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
Pc,
r ,
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) Salaried Employee -
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): Salaried Employee
(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 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 XNo: 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.
X 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 S :MIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS C*AP IT NSAT • , CEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHA saw((7 `E• - THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD. 1
. /
it
Signa . of obbyis
I do solemnly swear that all oft - •'--••ing fa are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Mia • -- : '••° nd all reporting requirements.
Signature of Lobbyist: 110
Signature of Principal/Client: __=
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID—
Form of Identification Form of Identification
Personally known(Lobbyist) 7Z Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOT• ----- -.,. .-'-' - . 7— - 1 V2tAl Cts L
State of Florida,County of Miami-Dade =1-,......� . °ti,.a` �u1yj f§ '` • County of
Sworn to ubscribed bef re me l 1' ,°R;�� a� 4.- one,bFg, - • subscribed befor- me L.This b day of ,201 ` - - --: •ay of /, . , ,. 201S'mor4_,Nty ,aw
Si. I hiL ,,,,
..t '-•f Public N a —State of Florida :T ure of Pubic ota State of Florida
ary � ry
Notar zation of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ - MCR# Date.Paid •
Lobbyist Registration Form received and verified by: • '` -
-F:\C1ER\$ALl.\aFORMS\LOBBYIST FORMS\LobbyistAnnuai Registration Form.doc Revised 01/22/2014
0
BRUIVILDA SUAREZ
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc Notary Public, Stite of New York
No.01SU6114147
Qualified in Kings 1 ,:
Commission Expires :Q ' ?a IL
/V\ iA1\A : EACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granada, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax:305.673.7254
LOBBYIST NAME: Li 1 i Bach
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
aut. ati, ally s •ended from lobbying until all fines are paid, unless the fine has been
ap e.I= • ami-Dade County Commission on Ethics and Public Trust.
„0„,,•l
Si• ,ure: _ Date:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc