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Michael Llorente - Nick Mazorra and Ray Gonzalez 'rr-o Ikt,f gam; MIAMIBEACH City of Miami Beach Office of the City Clerk016 JIur -0 FY; 2: { i0 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. U,or2Xl, ViCi/aU NAME OF LOBBYIST: (Last) (First) (M.I) U5tA b �U„ ytl - I�Px I -Arthur (>dre) 94 4(qo.14DI , MP,, -FL ,�)t'0 BUSINESS NAME AN ADD ESS (Number and Street (City) (State) (Zip Code) TEL �oS �A-� - 5�s� �lartek,U,c 014-e i Pcr rs, TEL PHONE NUMBER: FAX ■ MBER: EMAIL: COM Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY; NAM�Frct vl AL/ LICE ENT; '^U_ inb(r (970S1-7‘ �IVII I(1-F L BUSINESS NAM'. • •ADDRESS (( u_ rand Street) (City) (Statd) (Zip Code) 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: 6.0y-f/j' e, • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE IOWNERSHIP INTEREST IN SUCH CORPO T , PARTNERSHIP OR TRUST: t � t� 90 6 f II.SPECIFIC LOBBY ISSUE: C-1(f) l'en—SeANIC6--- Issue to be lobbied(Describe in detail): uLiCITY 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 ?hied ✓ C' C OinrD lc5 Thn �l ✓ C: c{ Pursuant to City Code Se • 2-482(g)Evea 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 IQ/Pr • F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc fA IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) ^ „A _ti) 61/01 f MTuv r ot5Iree i } B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION (REQUIRED), 1 ,1041I L NU”' cudriPiC ¶1QY1lLYtt . The llowin Information must be answered: fo g 1) Pursuant to Miami Beach City Code Section 2.488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Zo ":s _Yea : Are you lobbying on a present or wending,bid for goods.equipment or services,or on a nreseldt or pending award for goods.eauloment or service? 2) Pursuant to Miami Beach City Code Section 2.490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate D elopment Issues': ---Yes No: Are you lobbying on a pending aoplicatlonfer a Development Agreement with the City or application for phanae of zoning Chap designation or chime to thseCltVs 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 corn nsation or reimbursement for the appearance, whether direct, or Indirect, to express support of or opposition to any ,shall register with the clerk as required by this section but,shall not be required to pay any registration fees. .Yes o: Are you representing a notfor-profit�oragQn or entity withoutapecial compensattooat or reimbursement, V. SIGNATURE UNDER OATH: O : -U 'Y 28 •F E.CH EA.. EACH LOBB i; :._,, = : O THE CITY CLERK A S t N_.. =e tr 1:i -,, .■!_I. 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, /V-■{7.Vr./e‘e Signature of 4.bbylst I do solemnly swear that all of the foregoing facts are true an. =nd that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Bee ,;ty Code a�• . I ••- ••a•„r•!.uirements. Signature of Lobbyist L/� . A,—. Y.',A�_ _ Signature of Principal/Client: , I it .' • i rm t A t ii. _,`y��rl�- Vi. LOBBYIST IDENTIFICATION: r. PRI IPAL IDENTIFICATION: nuK �P _Pro uced ID ,, W.ri x Produced ID Form of Identification AV I1, . Form of identification Personally known(Lobbyist) 9 al v.s z _Personally known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: �03 o State of Florida.County of Miami-Dade ;' i. r State of Florida,County of Miami-Dade Sworn to and subscribed before me H m a o,�,, •m and subscribed before me This day of C' YUt? 1S2 G g r day of /�_•„ 2nl� i �J �,�, � 111 4"/ ;�4'',w ai; •; JUANITA E.HERNANDEZ Signature of Public llNota - MY EXPIRES:December q er 18201 Notary-Stet@ O1 F10r1 Si St;� a �e �'' b IC �+-ry-3te :''r �`.��; EXPIRES:December 2,2018 Notarization of Lobbyist's signature Notarization of principal's sign ,o'�•n„P' Bonded Thm Notary Public Underwriters TO BE COMP L 2 BY CITY CLERK'S S NLY Annual Registration fee: ( 3 Yes[otti No Amount Paid 8 Melt U Date Paid 66-Or'rh Lobbyist Registration Form nicely verified by: 5 F:ACLER\*ALt.atfORMS;.Oatlti1STFORMS'l LoubyiskAnnual'AtgistatiorsFarnndac. Revised 01/22/2014 F:ICLERI$ALLIeFORMSILOBBYIST FORMSU-obbyist Registration Form.doc MIAMI BEACH 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: ate e 1,‘-6(Q► ` C 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 17 (Ol � f7 Signatu-e: Date: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc Miscellaneous Cash Receipt CITY OF MIAMI BEACH , =r 3 ❑ Cash 0 Credit Card . heck# U $ C Received of / - //r-,t� ct.e_I L.1 o r C.'�a Address A) , c L / �,t2 ri,rci I\xt,1 G Jf`j t r ,.t \, St)1 i—pitt d r l'.'!2+-1 t'$, f -C.\ J For l S ..� �'v�rt J`J 1 .�-.(it 0.1 ' (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director 1 Account Number: 0// • 0000 -,2 9' `-/L/(/ . of? - '3O'7-. 36s . ©a.d Oo- c=c- :1 Y L. Preparers. -. `,c.,' JON) --1,4-1V.1~7-_,a( Dept: C- £— - E)CT: 711. /t .. 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