Edgar Amaya - Daniel and Beth Martin 560 RECEIVED
t,
NII M V 1 I B EAC El Office of the City Clerk FEB -4 2020
. 1700 Convention Center Drive
Miami Beach, FL 33139
305.673:7411 CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
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 ofany ordinance, resolution, action or decision of any commissioner; any action; decision; recommendation of.the City ..
Manager or any City board or committee;or anyy action,decision or recommendation of any City personnel during.the time period of the
entiredecision-making process on such action, decision or recommendation that foreseeably willbe heard or reviewed by the City
commission,:ora 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 City Code Chapter 2,Article VII, Division 3, entitled"Lobbyists,"
for additional information..
Instructions:,Please complete all sections ofthis form and submit the completed form,with the applicable fee, to the Office of the City
Clerk. If you:need more space to complete an answer, use a separate sheet(s).of paper. If you have nothing to'report in a particular
section, you must write "none" or "n/a" in that section: Any change to any information originally filed; or any additional City
Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amendment to the registration form.
The lobbyist_has a continuing duty to supply information and amend the forms filed throughout the period that the lobbying occurs.
Separate registrationformsshall be required for each principal represented on each specific issue.
I. LOBBYIST INFORMATION:
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NAME.OF LOBBYIST (LLst) (First) (Middle Name)
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LOBBYIST BUSINESS NAME AND ADDRESS . (Number and Street) (City) (State) '(Zip Code)
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LOBBYIST BUSINESS TELEPHONE NUMBER ' CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
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NAME OF PRINCIPAL. '(Last) (First) (Middle Name). .
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PRINCIPAL BUSINESS NAME AND ADDRESS ' (Number and Street) ( ity) (State) '(Zip Code) '
3051— - 6 -a - 61- -o
PRINCIPAL BUSINESS TELEPHONE.NUMBER CELLULAR TELEPHONE NUMBER ' EMAIL ADDRESS
As2HEER 2-482(h)(1)(a): ailajaillAitfpidimu w. .. .(610, .. . di,no ailik C'u"0&A<.[-x-��yIn a lobbyistGin I Q�t
ffi special compensation cr reimbursement' ID appearance,viii indirect,CP contingent CDCW 9 su•.ort 01102 o••osition
Dili tnii daare•isterMI the @ mre.uired4.9 n4�'1b Meta 2,r2G)re.wed it)1351707p re.istration fim
If the principal is a Corporation, Partnership or Trust, the following information MUST be. provided
pursuant to City Code Section 2-482(c): WA-
•
• . NAME OF CHIEF OFFICER, PARTNER,OR BENEFICIARY(if none,write N/A): 'NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
/UM'�� a
CORPORATION;PARTNERSHIP OR TRUST(if none,write N/A):' . /J/
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Page 1 of 5
III. ISSUE TO BE LOBBIED:
Describe with as much detail as is practical, including but not limited to a specific description where
applicable of a pending request for proposal, invitation to bid, or public hearing number:
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IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to.City Code Section 2-482(a)(4), list the City Commissioner or City personnelsoughtto be
lobbied, and whether the lobbyist has entered into any contractual relationship (paid or unpaid) with
said City Commissioner or.City personnel from 12 months precedingsuch commencement of service
with the City to the present date, stating the general nature of the subject contractual relationship.
Full Name of Individual and Contractual Relationship (If yes, explain) YES NO
O
Title of Person to be Lobbied
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.
List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an
appearance of impropriety.(if none,write N/A):
. . ful �.
V. DISCLOSE RATE AND AMOUNT.OF LOBBYIST COMPENSATION — Be Specific. (Note that a
contingency fee is prohibited pursuant to City Code Sec. 2-485.3):
49
137-r fief !iv \
Page 2 of 5
The following six(6)questions MUST be answered:
1) .: Pursuant to City Code Section 2-488,entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues":
_Yes N 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 City Code Section 2-490, entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development
Iss es":
Yes_No: - _ Are you lobbying on a pending application fora 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 City Code Section.2-482(h), any person(except those exempt from the definition of "lobbyist" as set forth in
Section 2-481)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 city clerk as required by this section,but shall not be required to pay any registration fees.
Yes o: Are you representing a. not-for-profit corporation or entity without special compensation or.
reimbursement?
4) Pursuant to City Code Section 2-481,the term "lobbyist" specifically excludes the following.persons: Expert witnesses who
provide only scientific,technical or other specialized information or testimonyinpublicmeetings;any person who onlyappears.
as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether direct;
indirect or contingent,to express support of or opposition to any item;and any person who only appears as a representative of
not=for-profit community based organization for the purpose of requesting a grant without special compensation or
reimbursem t for the appearance.
Yes' Are you providing onlyscientific, technical or other specialized information; appearing as a:
representative of.a neighborhood association without special compensation or reimbursement or
representing a not-for-profit based organization for the purpose of requesting a grant without
special compensationor reimbursement?
5) Pursuant to City Code Section 2-491(1), no campaign consultant shall lobby the City Commission for a period of 12 months
following the swearing in of any elected official(s)for whom the campaign consultant provided campaign consulting services
within the past election cycle:See Section 2-491.for more information:
_Yes Have you provided campaign consulting services to an incumbent member of the City Commission
within the past election cycle?If yes, please list the incumbent member(s)of the City Commission:
—Yes if yes, has it been less than 1�2 months since the elected official(s) whom you provided campaiq
consulting services was sworn int
6) Pursuant to City Code Section 2-482(a)(4)a., a lobbyist who has within the past election cycle provided campaign consulting
services to an incumbent member of the City Commission (which lobbying activity is not otherwise prohibited by Code section
2-491) shall disclose such particular:service on his/her lobbyist registration form and shall orally disclose such particular
service bef relobbying the City Commission at a public meeting..
Yes o: Have you provided campaign consulting services to an incumbent member of the City Commission
within the past election cycle? If yes,please list the incumbent member(s)of the City Commission:-
_YesVo: if yes, were you promised or did you receive economic consideration in exchange for campaiq
consulting servicesi
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:\CLER\;ALL\aFORMS\'LOBBYIST,:FORMS\Lobbyist Registraction.Forr.Revised 09-20-18 REG.docc - . - Revised 09/20/2018
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VI.. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE E CITY CLERK A
SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION.
RECEIVED, FOR THE PRECEDING 'CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAGED TO LOBBY: A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENSATION DURIN . THE REPORTING PERIOD.
Cl
Signature of Lobbyist: i/// 8 Date '6 ( .��-
I
do solemnly swear or affirm that all o the foreg.ing facts, statements, and disclosures in this form are true and correct,=
and that I have read or am familiar with the pr•.' •ns contained in Chapter 2, Art. VII; Division 3, entitled "Lobbyists" of.
the Miami Beach City Code and all reportin. . . e a",/:
Aii, O� 2..D
Signature of Lobbyist: . : . . ��r, Date:. .
`pie
Signature of Princi•.I:. � ra /_ %: Date deo
ter'
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of. c a 1 b I\ State of FL
County of: 1il L l'DE County of: /�//G�'K.. to
Sworn tip (or affirmed) nd subscribed before me Swo to(or affirmed)and subscribed before me
this � . day of. €bu-�j't , 20&, by this L day of €6PAA A.tY ,.2020, by
PA,h-b1,— Al's inik Is9 ./tFL /1A-cri?V
NAME OF LOBBYIST NAM�F PRINCIPAL
Produced'ID P'— b L- s/ Produced ID f-L 1.--
FORM
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
Personally Know Personally Known
S' ature of Notary.Public. :. . Si re of.Notary Public
Name of Notary,Typed; Printed or Stamped Name of Notary, Typed, Printed or Stamped
—– SO- :s JASON SALVATORE—---
o*:tyke, JASON SALVATORE
(NOTARY SE .; MY COMMISSION#GG030527 (NOTARY SEAL) a • , MYCOMMISSION.00030527
- ,_;o EXPIRES:September 14,2020 ‘•
"� �f EXPIRES:September 14.2020
Vida? SandedThru Notary Public Underwriters i'P�i rof Notary
Public Unde itet�.
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1 The term"lobbyist"specifically excludes the following persons:
Expert witnesses who provide only scientific,technical or other specialized informationor testimony in public meetings;anyperson who
only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether
direct, indirect or contingent, to express support of or opposition to any:item; andany person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for
the appearance.
Page 4-of 5
MIAMI EA l
City of Miami Beach, 1700 Convention Center Dnve,Miami Beach,Florida 33139,www.miamibeachfl.gov
Office of the.City Clerk
Rafael E.Granado,City Clerk CityClerk@miamibeachfl.gov
Tel:305:673.7411;Fax:305.673.7254
1171q,11, 1,,
NAME OF LOBBYIST: "
1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT
Pursuant to City Code Section 2-485(d), the City Clerk shall notify any lobbyist (or.
principal)who fails to file timely a Lobbyist Fee Expenditure and Compensation Statement
(Statement). In addition to any other penalties that may be imposed as provided in
Section:2-485.1, a fine of $50.00 a day shall be assessed for Statements 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.
Anylobbyist, 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.
I hereby acknowledge that on February 28 of each year, I shall submit to the City Clerk a
signed Statement under oath listing all lobbyist expenditures, as well as compensation
received, for the preceding calendar year with regard to the specific issue on which I have
been engaged to lobby.
2) LOBBYIST WITHDRAWAL
Once an issue I have registered to lobby has concluded or I am no longer lobbying oil
that issue, I shall immediately file a Notice of Withdrawal with the Office of the CityClerk.
3) ANNUAL LOBBYIST REGISTRATION FEE
I understand annual registration of all lobbyists shall be required for each 12-month period
commencing October 1 of each year, and the fee for such annual registration shall be
$500.00 pursuant to Section 2-482 of the Miami Beach City Code.
Signature of LobpfrC7) ,
Date
F:\CLER1$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc
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