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ANN BEAC H:
Office of the City-Clerk
1700 Convention Center Drive CITY OF MIAMI BEACH
• Miami.Beach;FL 33139 OFFICE OF THE CITY CLERK
'305.673.741:1
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"Lobbyist"has.specific:exclusions. Please-refer to City Code Chapter 2,Article VII, Division 3, entitled "Lobbyists,"
for additional information.
Instructions: Please complete all sections of this 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 tiled throughout the period that the lobbying occur;.
Separate registration forms shall be required for each principal represented on each specific issue.
I. LOBBYIST INF RMATION:
NAME OF LOBBYIST ��
(Last) (First) (Middle Na e)
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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 ADD SS
II. PRINCIPAL INFORMATION:
0 R.> DA-l!/ram
NAME OF PRINCIPAL (Last) (First)
(Middle Name)
31
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PRINCIPAL BUSINESS NAME AND ADDRE / A . V fr 1 e) i � e)(Number and Street) (City) (State) (Zip Code)
5(nd- 743- q`7// Lai i..pNI Gu wt.a,Q,cal
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
Pursuant to City Code`Se"ction 2482(h)(1)(a)i A"principal at any'oorporation,'paitnership,or other'entity who`appears°as a'Iobbyist on`behalf of that
entity,;without special compensation or reimbursement for the appearance,whether direct,indirect,or contingent,to express support of:or opposition to
an item shall register with the Clerk as required by this subsection but shall not be required to pay any registration fees.
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided
pursuant to City Code Section 2-482(c):
NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write N/A): Kr OAVI 2 1U )
NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%.OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION,PARTNERSHIP OR TRUST(If none,write WA):
Page 1 of 5
. �r
Ill. 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 personnel sought to 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 preceding such 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
Title.of Person to be.Lobbied
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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):
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):
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`$fNo: • Are you lobbying on a present or pending bid for floods,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
Issues
—Yes No: 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 Cites Future Land Use Map? 3
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.:
Istyes.;_NO: 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 testimony in public meetings;any person who only appears
as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether direct, i
indirect or contingent,to express support of or opposition to any item;and any person who only appears as a representative of t I
not-for-profit community based organization for the purpose of requesting a grant without special compensation or
reimburserent for the appearance. t
_Yes {No: , Are you providing only. scientific, technical or other specialized information; appearing as a
as, representative
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 compensation or reimbursement? - n
5) Pursuant to City Code Section 2-491(1), no campaign consultant shall lobby the City Commission fora 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. '
i _Yes'Not Have you provided campaign consulting•services to an incumbent member of the City Commission
within the past election cycle?If ves,please list the incumbent member(s)of the City Commission:
Yes 'ISo cf y s es, as s its beensles was han 12i months since the elected o fficial(s) whom you provided campaign
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 before lobbying the.City Commission at a public meeting.
_,;Yeg*No: Have you provided campaign consultinq 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:
li
Yes No: If yes, were you promised or did you receive economic consideration in exchange for campaign -
kpc consultinst servlcea?
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
. Annual Registration fee: [ I Yes Wo Amount Paid S MCR# ti l
Date Paid v
Lobbyist Registration Form received and verified by;.
FACLER\SALLNaFORKS5 Ld8RYr5TFORM51LobbyistRegistrationFormRevised 03-t1-20REG.doc Revised 03/11/2020
Page 3of5 ;
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VI. SIGNATURES UNDER OATH:
i
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE 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 COMPENSATIO DURING H EPORTING PERIOD.'
Signature of Lobbyist . Date. - 1 a`
I do solemnly swear or affirm that all of the foregoing facts, statements, and disclosures in this form are true and correct,
and that I have read or am familiar with the provisions contained in Chapter 2,Art. VII, Division 3, entitled"Lobbyists" of
the Miami Beach City Code and II eporting re • ments..
Signature of Lobbyist ate q. i --9i
Signature of Principal: z, , ?c- tr,. "11,,,/ Date "l ' /-2
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of F Q►Z IQ/ State of
County of NI I I, —J/M)- County of ; ,
Sworn to(or affirmed)and subscribed before me, Sworn to(or affirmed)and subscribed before me, j`;
by means of 0 physical presence by means of 0 physical presence
.,
or 0 online notarizati� s or 0 online notarization,
this day of (< >'I(� 'C 30_�by this_day of 20_, by
3 rg.► _Der I o IU-Lo
NAME OF LOBBYIST NAME OF PRINCIPAL
Lroduced ID j7 to\f"t Q;ti Opt J fzi. Lic.,e -g _Produced ID
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
6 .5(:)` 5Ala `pa,- SSb 0 ,
_Personally Known _Personally Known
sy:
Signature of Notary Plublic Signature of Notary Public ,
Name of Notary,Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped
'.'.B,L" RAUL CHAVARRIA
(NOTARY SEAL) (NOTARY SEAL)
i COMMISSION it GG 953280
� /P.
42 a EXPIRES:March 6,2024
no,- Beaded TMi Budget Notary Services
1 The term"lobbyist" ,
excludes the following persons: »
`:z
,,
Expert witnesses who provide only scientific,technical or other specialized information or testimony in public meetings;any person who a
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;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 reimbursement for ;
the appearance. ,
Page4of5
•VI: SIGNATURES UNDER OATH ` ,
ON•,FEBRUARY"23 OF EACH YEAR.=EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERIC A
•SIGNED STATEMENT UNDER OATH`L•ISTING LOBBYING .EXPENDITURES. AS WELL AS 'COMPENSATION
'RECEIVED.'FQR-THE;PRECEDING—CALENDAR-YEAR Writ-i AEGARD TO THE SPECIFIC ISSUE.ON WHICH THE
LOBBYIST ' BEEN ENGAGED O LOBBY 1A TA MENT• HA • I ERE A EEN'NO
EXPENDITURE D COMPEN DU RUING P€RIOO?
Signature,ofbLobbyist babe
I cio;solemriiy'aWear or affirm that;en of the foregoing facts.statements,and"disclosures In this formate true and correct.
and that I have toad oi,am tamrttat.wltlt ho oorlm provisions hled in ChaRber;2;-Att Vil.D{vision, entitled _Lobbyist?of
the°Miami Beach City Code teporlina i egya@mr inter j ,
Signature of:Lobb rist , .,Dabs 1(,cI/ '
Signature o Prin;ipal • 17a.v;� 7Vt,-1 Date '`1 I T I -7;..,=
VIL,NOTARY SIGNATURE AND SEAL: b • •• . . .
LOBBYIST: PRINCIPAL .•..
.
l of r�l'L 10/- Will' C/1�JI
( ..� Co ►of: 1'(Qm.t -- ',. °
Swamto,(or affirmed)and sttbsc ibed Defoe me, , Sworn to(or subscribed
before roe,
by means of 0 physical presence , _ by means at presettoe
`O,Onthle notarization, ' - or O on'Irie notarization. •
this day of .20_,by , this day of C Q)C 1 I .2Q4gY.
NKME!?FLOG8YIST �'" / NAME of PRINCIPAL 'r
'' Produced ID Produced ID t'')f i-rA ,�.1C7'I�r
OF roemFl�TION• tom,vk�rosr �canoN
_.. Known- . +, Signature +-
•
of Notary.Public Signature of Nci(ly Public •
. , ,f?y,nr,-4- r .0-ihn • ' .:'..:-.- -
Net„.of Notary$Typed,Printed or'Starnped • Name _ ' ' ,
(NOTARY SEAL), • (N ' N " r
�!nma�wwl- f1r�'P,�r�y�vsn{�=NDf�ryBaal/ 3 f
Bonet J.Kenn,Notary PUbiia. ' ' . '
Ph0de1p610County I
commisstori 023
i The 4a .lobbyN�vodka/asctudas the ►p plat My C.ommlulon number 123 June4 2 9
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Expert Ntitrlas as who provide only trdardkfc.`tachriod or other specialized ps:.nyaaraon who
onti appears as a represent.**of .ris phb rhoad rssorietlon•wWhoo oafttp aatioo or Airnbu►sement br the appearance,-whether
kidlrsd or aarttlrrpraro.Ip rooms support of or opposiboh b any Item;;.and any parson who only appears as a representative of
pec,fot.prostooromunny tad Organization br tha purpose of rle400lling allnlit without*der!compensation or retmburaament for
the aPP t
sw
Page 4 of b an tip OM1•• ,, , bafara ma
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IS
MIAWUB•EACH
City of Miami Beath,1700 Convention Center Drive,Miami Beach,Florida 33139,.www.miamibeach8.gov
Office of the City Clerk
Rafael E.Granath?,City Clerk CityClerk@miamibeachfl.gov
Tel:305.673.74I i,Foxy 305.673.7254
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NAME OF LOBBYIST: [ Tr 6,,,,,w, , ,
1) LOBBYIST FEE EXPENDITURE,AND COMPENSATION STATEMENT
Pursuant to City Code Section 2-485(d), the City Clerk shall notify any lobbyist (or lti-,.
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 `x
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 ,.a
ek.
'Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the l
assessed fines after notification:
•
Any lobbyist, who fails to file the required Statement by April 301h 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: 1.
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 .x`
been engaged to lobby. 4;
2) LOBBYIST WITHDRAWAL `t
Once an issue: I have registered to lobby has concluded or I am no longer lobbying on
that issue, I shall immediately file a Notice of Withdrawal with the Office of the City Clerk. q..
PF,
3) ANNUAL LOBBYIST REGISTRATION FEE sr,`
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 s'
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