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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139 ' -E � �
LOBBYIST REGISTRATION FORM g
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks;to'-ericourage thelpassage, defeat or
modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the City
VIIS 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.
Cu I do 5-heicy C✓
NAME OF LOBBYIST: (Last) (First) (M.I)
al 04-0 iZ .OL. SO v fiv trU 1►to Z Colter(); 11 DcQ 7"-, Ei .3a? U
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(5c01- C'I31 S-C) C k)Icke VVlo`ivrrOf4So (Ui•looj CO ''1
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY: Ci'j,cJ ,� r 11'10 �r d l rti S� �c�fi ,.S ,S�c� � / ro Siic
NAME QF_PRINCIPAU LIENT: /
r I P' PAU?U fi}O n s • I q(o2. Ceti v rr 1 i r&O TAM F( 3Q8
BUSINESS NAME ADDRESS Number and Street) (City) (State) (Zip Code)
69 CD, 933 5y 30._
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)]
C rcs 0o , Q 13rota a-9 / CEO
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY:
C1-101 kLl 2.esca ck) G!0 to&I ,noehks (o5) ,,c,1 1 ./2.eiAi e Pr,ce 14ssoc G.
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: VG 10 t Ac1- C6P i '-Q f Yl("la 5 rt'yl ISla c,_ Q aciL°E roc,.
u.SPECIFIC LOBBY ISSUE: ®rblS `-►uect°"e ►t rWsiAt 11.Tr3. `rv`r i6cl`'5uoscl C�aracsfirAc,,
EFP 1.procvr--rynevet Por 1'mo roIc, CorM1'►�IU..�1iCal°v,A)s p/oof UC4-S t.r CA Sf�r"!✓icV,
Issue to be lobbied(Describe in detail): qA e a;1L
lll.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 'resent 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
nika403serri acivnt isf-tc$' ,&i, iff nonce
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C. � 0 erney s ofd`c c nma yore/ £Srl eua no n
Aft mrmiotts of L c'or\not;s ('c
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
Not ca p pkc&ko1e
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
SCtlaym• ed ' ployr.e.
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST C MPENSATION):A
(REQUIRED). I G(,' _ci plOy e
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":
_ �_ : lobbying on a present or pending bid for goods,equipment or services,or on a present or pending
Yes No. Are you obbv q p p g q p p
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 \.Z: 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.
Yes 4 o: 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 C CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION REC IVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF ,H;RE HAV B N NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
4 ,4 , ,IiL
Signature of Lobbyist a
I do solemnly swear that all of the foregoing facts e true and correc and that I have read or and familiar with the provisions contained
in Section 2-482 of the Miami Beach Cit, Code a i% reporting r: .''eme t..
9 Y
Signature of Lobbyist: 1 11 ' CA__/'Signature of Principal/Client: ��ih rA a- _ A
7 /
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
/Produced ID or i uers L`cei/i 5'€ L Produced I D I�'(11 5 l.t CCr1 1
Form of Identification r- Form of ldentificatio
Personally known(Lobbyist) ---Personally known(Principal)-R:
VII. SIGNATURE AND STAMP OF NOTARY: $R'A
State of Florida,County of Miami-Dade State of Florida,County of Miami-Dad
Sworn to and subscribe• •efor me Sworn and subscrib-d be •re me ~
This _ - day • lit.' .201- _ ay of %�k.Li1 , 20 _ i"'$
c WIP r
S •`e u:of P.•li•' •tary-State .f Florida Q _ Si•Firtur- of P/i ''otary-St. if Florida = ,,_�
arization`f L• •bvist s signature 1 N• arization - Principal's si• -ture �, *11
TO BE COM1'Lt to 6 CITY CLERK'S STAFF ONLY
Annual Registration fee: Yes[ ]No Amount Paid$ ' MC- # I" {e Z Date Paid 'Mi
Lobbyist Registration Fo eceived and verified by:
F:\CLER\$ALL\aFORMS\LO, BYYST FORMS\Lobbyist Annual Registration• •r' oc Revised 01/22/2014 _
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
. .
fk I AIM I B E AC H
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
S �`
LOBBYIST NAME: Ci'dL,�
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 s spended from lobbying until all fines are paid, unless the fine has been
appealed to th.: iami-Dade County Commission on Ethics and Public Trust.
DZ 0 /,c
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Signature:
111 Date:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
. .
MIAMI BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www.miamibeachfl.gov
City Clerk's Office
Tel: 305=673-7411
Fax: 305-673-7254 Office Use Only
ANNUAL LOBBYIST REGISTRATION FORM
Name: S1-C-` CVdL
Business Name: ( O ,21Ci S6 1_v- S
Address: 9(P2 Cr 3a 30(U
Office Telephone Number: cZ)-- 9 3 3 - 30
Cellular Telephone Number: "Zj 93 3- 5-1-13 0
Email Address: J . Ch r d C_ 2 VVl C3 rD(c sv(U .o,S. COvvi
If more than one lobbyist,please list:
1)
2)
3)
4)
5)
6)
7)
Submit this form to the Office of the City Clerk, along with a check for $500 for each
lobbyist. Please make the check(s) payable to the City of Miami Beach.
For City Clerk's Office Use Only
MCR#:
Amount paid: Date paid:
• Processed by: Date:
F:ICLERI$ALL1aFORMSILOBBYIST FORMSIANNUAL LOBBYIST REGISTRATION FORM reg.docx
. � . .t Miscellaneous Cash Receipt „ -_-,) ,,_.2-1 .^E.r a;t t� V riot i �t
CITY OF MIAMI BEACH }i::- . t:, ; B„i . -loi0
$856,00 -
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❑ Cash Credit Card Check# : $
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Address I 9(n-2.... it e c-)4e ' vi-\\.c. it-14e. , Tc \ , .-CJ .
For P _Pro c- Li f C r o( . i C o A cat C 4 -• t)c t )�.f 4 y 41, c
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( \ gy�0 to � �”e el r�'�(el �{-.tom � ) is 5 L..(
(THIS INFORMATION MUST BE COMPLETED) Office of Finance Director
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C) 0 k O° c Account Numbs.. -30- (i Li
+rat,k C��� Dept: C A�X ire k ExT: ?if lr
Preparer. p
• CITY HALL CASHIER OFFI
1700 CONVENTION CNTR DR
MIAMI BEACH, FL 33139
10/08/2015 12:30:35
ef:tilli
CREDIT CARD
AMEX SALE
CARD# �"°'""-
XXXXXXXXXXX 1002
Chip Card: AMERICAN EXPRESS
Chip Card AID: A000000025010801
ATC: 0003 City of Miami Beach-Florida
TC: 00E4D2B8A97664F2 Finance Department
INVOICE 0005
SEQ#: 1 City Hall
Batch #: 0005 1528120-1 10/08/2015 BR1 T131
001261 Thu Oct08,2015 12:30PM Trans#17-17
Approval Code: 808410 17 $850.00 MCRCLERK - MCR-City Clerk
Entry Method: Chip Read * MCR#: 408027
Mode: Issu er 1 ITEM(S): TOTAL: $850.00
:
SALE AMOUNT Credit Car PAID $850.00
$850.00
Have a nice day!
CUSTOMER COPY
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