HomeMy WebLinkAboutArgelio A. Rivas
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Email: dtyderk@ci.miami-beach.f1.us
LOBBYIST REGISTRATION FORM
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(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-4B1)
o Check Box if an Amendment (Co?? -t ;,a:~ ~
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NAME OF LOBBYIST: (Last) I )first)
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BUSINESS ADDRESS: (Number and Street) (City)
.1) DATE QUALIFIED AS LOBBYIST
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(2ip Code)
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TELEPHONE NUMBER:
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FAX NUMBER:
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EMAIL:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAl/CLIENT:
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BUSINESS ADDRESS: (Number and Street) (City)
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TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (e)l
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
. LIST ALL PERSONS HOLDING, DIREffi Y OR INDIREffi Y, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARThlERSHIP OR 1RUST:
II. SPEaFlC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
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m. C1Y AGENaES/INDMDUALSlp B~ LOBBIED:
B) Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RA TE OR OTHER).
A) LOBBYIST DISCLOSURE:
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B1 PRlNCIPAl'S DISCLOSURE (OF LOBBYIST COMPENSATION):
1)
Pursuant to Ordinance No. 2003-3393 AmendinG Miami Beach City Code Chamer 2 Article VII Division 5
Thereof Entitled ftCamoaian Finance Reform" Via The Addition Of Code Section 2-'1BB Entitled ftProhibit~d
Camoaian Contributions 8v Lobbvists On Procurement Issues":
Are YOU lobbylna on a Dresent or DendlnG bid for Goods. eaulDment or services. or on a Dresent
or oendinG award for Goods. eGuioment or $ervice? 0 Yes II-No
2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled ftCamDaian Finance Reform" Via The Addition Of Code Section 2-'190 Entitled ftProhibited
Camoaian Contributions Bv Lobbvists On Real Estate DeveloDment Issues":
Are YOU 10bbvinG on a DendinG aDoliation for a Deyelooment AGreement with the City or
aDDliation for chanGe of zoninG maD desiGnation or chanGe to the City's Future Land Use MaD?
DYes ~o
V, SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, UsnNG LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR.
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 as amended, and all
reporting requirements.
Signature of Lobbyist: 9~ q~ ~
Signature of Principal/Client:
VI. LOBBYIST IDENTIFJCAnON:
Q Produced ID
~rsonally Known
Form of Identification
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This / V day of ~ . 2003.
Registration: [ ~
If rejected, state reason: ....--
Registration fee paid: [0/fe5 } ] No
DATA ENTRY DATE: 10/ 7
I
FOR CLERK'S USE ONLY
] REJECTED DATE:
1t)/~/03.
I
[ ] Cash [ ] Check MCR " "-
. 2003 ENTERED BY: c~
F:\ R\HATL\Lobbylsts\reg.stratlona03.doc
2nd ReviSion 3/18/03