Bob De la FuenteCity of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
Emaih cityderk@ci.miami-beach.fl.us
LOBBYZST REGISTRATTON FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
o Check Box if an Amendment
NAME OF LOBBYIST: (Last) (First)
(M.I) DATE QUALIFIED AS LOBBYIST
BUSINESS ADDRESS: (Number 'and Street) (City) U (StatiC) ' (Zip Code)
13o<,) ~3b- Il ~.P ~3o~'~ ~.-3~- ~ ~ ~ ~~ ~l~,~. ~
~PHONE NUMBER: -F~ NUMBER: EMIL:
T. LOBBYZST RETAZNED BY:
NAME OF P~NC]PA~C~E~:
BUSINESS ADDRESS: (Number and Street) (CiW) (Sta~e)
~LEPHONE NUMBER: F~ NUMBER: (Optional)
i~c )
EMAIL: (Optional)
Fill out this sec'don if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
· NAME OF CHIEF OFF[CEA, PARTNER, OR BENEF[CLARY:
· I_~ST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
1/. SPECZFZC LOBBY ISSUE: ,
' U
Issue to be~6bbied (Dt~cribe in detail~. (J
III. CITY AGENC/ES/INDI'VZDUALS TO BE LOBBIED:
A) Full Name of Individual/TiUe B) RelaUonship
FLAT RATE OR OTHER):
A) LOBBYIST D]SCLOSURE'.
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
2)
Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chapter 2, Article VII. Division 5
Thereof Entitled"Camoaicln Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaion Contributions By Lobbyists On Procurement Issues":
Are you Iobbvina on a of=ae~t or oendina bid for aoods, e~uioment or services, or on a oresent
or oendina award for qoods, eauiament or service? Yes No
Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article Vii Division 5
· " i n
thereof Enbtled CamDa o Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions Bv Lobbyists On Real Estate Development Issues":
Are you Iobbvina on a oendina aoolication for a Develooment Aereement with the Cit~ or
aoolication for chanQe of zoninq mao desiQnation or chanqe to the City's Future Land Us~ Mao?
Ye~ NO
v. S[GNATURE UNDER OATH:
ON OCTOBER [ST OF EACH YEAR, EACH LOBBY[ST SHALL SUBMIT TO THE C~TY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR.
! do solemnly swear that all of the foregoing facts are true and correct and that ! have read or am
familiar with the provisions cont~' edwin Se~i/~ 2,~ of the Miami Beach City Code as amended, and all
reporting requirements.
Signature of Lobbyist:
Personally Known
Signature of Principal/Client: o
/
V[. LOBBYIST IDENI~F[CAT~ON:
o Produced ID
Form of Identification
S~GNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This c~-~ Id day of~ 200317
nat~i'~ of Public N~tary - State of Florida
Print, stamp or type name of Notary Public
FOR CLERK'S USE ONLY L/~
If rejected, state reason: _~ ~Keck MCR/~'~7);~Z//2 ~ ~/?
Registration fee paid'. []~. ] No , [ ~ Cash [
2nd Revision 3/18/03 ' F:\CLEZHAT~L°bbyists\registrati°na03'd°c
B] PI~NC~PAL'~ DL~LOSuRE (OF LOBBY~STCOMPENSATION);.
F-169
1)
Pumt~ant to Ordinance No. ~fl~_~-33g3 Amendina Miami Beach £1tv
Thereof Fntltled "Camnaian Finance Reform" Via The Addition Of C_nde
Camoaten Contril:)utions By Lobbyists On Procurement
~u~Suant to Ordinance No. 2QO3-~L~KIK Amendlna Miami ~ch ~ ~e ~a~ 2. A~cle ~ ~[~SI~ ~
· e~f ~ntl~ '~m~n Rnan~ Re~". ~a ~e AddlUon ~ ~e ~on 2~ ~f,u~ "~h~l
~moaian Co~bufions Bv I ~ On ~1 E~ ~eranmem I~Je~;
A~ YOu fob~ino on a Hndlna ack, lotion ~ a D~-~nnme~ Ao~t wJ~ the ~ ~r
anDli~o. ~r c~e ~ zonin~ moo ~T~nn or ~an~ ~ ~e ~'s F~ ~nd U~ HaD?
_Ym ~
V. ~c~-~NATURE UNDER OATH:
ON OCTOBER ~r OF EACH YEAR~ EACH LOBBYZ.qI' SHALL SUBHZT TO THE CITY c!FRK A S~GNED
STATEMENT UNDER OATH, L."STZNG LOBBYING EXPENDTI'URES IN THE C~.iY OF M'LaNZ BEACH FOR
THE PRECEDZNG CALENDAR YEAR.
! do solemnly swear that all of the foregoing f-acts are true and correct and that T have read or am
familiar with the provisions cont~ec~in Sect~ 2~4~ of the Miami Beach
reporting requirements. ////~./ ' City Code as amendecl, ancl all
Signature of Lobbyist: /T~Pr~'''
Signature of Principal/Cflenb
V[. LOBBYIST IDENTiFICATiON:
n Produced
Form of Iden~cation
~GNATURE AND STAHP OF NOTARy OR DEPUTY C3.ERK:
State of Florida, County of' Miami-Dada
Sworn to and subscribed before me
'r~ture of Public Notary - State of Rorlda
~t, stamp or type name of Notary Public
Reg~straaon: C ] ACCE~'p-D
If re]ecl:e~, sta~e reeso~:
Registration rea 10a~a: [ ] Yes [ ]No
DATA ENTRY DATE: ....
2ncl Revlon 3/18/03
FOR CLERK'S USE ONLY
[ ] RE]ECT~ ~TE:
[ ] ~,h [ ) c~ec~ MCR ~
~ 2~3 ~D BY:
F:~~S~~03~
F-438
B) pRINCIPAL'S DI_C~LOSUEE (OF LOBBYIST COMPENSATION):
l) ~yrsuant rD Ordinance No. 2003,339] Amendine Miami Beach Citv Code Chapter 2. Article VII. Division
Thereof Entitled "Camoalen Finance Reform' Via The Addition Of Code Sec'tlon 2-488 Entitled 'Prohibited
Camoakm Contributions Bv Lobbyists On Procurement Issues":
Are you Iobbvina on a present or mendlne bid for GoOds. eout~'~ht or ~ervlces, or on a oresent
or ~endinq award for qo~ds, eauiDment or service? Yes (No/
2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division
t_hereof E~titlod "Camoaien Finance Reform'. Via The Addition Of Code Section 2-490 Entitled ~Prohiblted
c..amoai~n Contributions BY Lobbyists On Real Est-ate Develooment Issues":
Are you Iobbvin~ on a ~endlno aonllcation for a Det/elonment Aqreemellt with the City or
a. Dhcatr~t~'~'6~ chanee of zen.ne ma~ de~ana/,on or chanqe to the City's Future I.and U~.~
v. SIGNA'rURE UNDER OATH:
ON OCTOBER ~.~r OF EACH yEAR~ EACH LOBBYZST SHALL SUBMZT TO THE r..,[~ Y' CLEI~ A SZGNED
~I'ATEMENT UNDEg OATH, I_Z~>~zHG LOBBYZNG EXPENDZ-rtJRES ZN THE CZ'FY OF MZAMT BEACH FOR
THE PRE('EDZNG CALENDAR YEAR.
solemnly swear ~hat a[I of the foregoing facts are corre¢:
of the Miami Beach City Code as amended, and all
Signature of Lobbyist: /~'- --
Signature of Principal/Client;. //
vz. 1.OBBY'J~T ZDENTIFICA'rION:
Produced ID
Form of Identification
Personally Known
V~I. SZGNATURE AND ~I'AHP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dada
Sworn to and subscribed before me u
This ~'~ ~ day of~ 200,3q'
$1'g n~at~e~~ o rid a
Print, stamp or type name of Notary Public
FOR CLERK'S USE OHLY /
if re~ecre~, sr.a~e reason: / I Cnecy, MCF~ ~Y~'~~ ~'
Reg,s[ra~ant'eeCalcr, [..,~e$ [ ]NO C ]Cas~ [ ENTEREDBY'.~'' ~U '~ ~
2ndRevSC / / 3 '