Daniel C. Mancini - Daniel C. Mancini r. RECEIVE[
AR 2 22
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MIAMIF •
.M 29 p•" `AC. Office of the City Clerk •
1700 Convention Center Drive_ CITY OF MIAMI BEACH
Miami Beach, FL'33139 . ` OFFICE OF THE CITY CLERK
305.673.7411
LOBBYIST.REGISTRATION`FORM -
.Lobbyist means all persons employed or:retained;whether:peid 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 specificelly..includes the principal"as well.as any employee engaged"in lobbying •
'activities. The term°Lobbyist"'.has specific exclusions..Please refer to City Code.Chapter2,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:fled throughout the period that the lobbying occurs.:
Separate registration:forms shall be required for each principal represented on each specific issue:.
• I. LOBBYIST INFORMATION:
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NAME OF LOBBYIST: . (Last) J (First) " (Middle Name) • -
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LOBBYIST BUSINESS NAME AND ADDRE S ' : (Number and,Street) " : •(Catty) : (State) " (Zip Code)
LOBBYIST BUSINESS TELEPHONE NUMBER :.CELLULAR TELEPHONE NUMBER =- "" :.EMAIL ADDRESS: .'
II. PRINCIPAL INFORMATION:
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:NAME OF PRINCIPAL • • • :(Last) (First): (Middle Name)
•
PRINCIPAL BUSINESS NAME AND ADDRESS : (Number and Street) : (City) (State) (Zip Code
• : PRINCIPAL BUSINESS TELEPHONE.NUMBER " " " CELLULAR TELEPHONE.NUMBER- ' .• • • ' "" EMAIL ADDRESS . "
: -ursuant c0(§ •• Section 2-482((h))(1arl A• I i•-I(.1ij corporation, partnership,(.�?. i f. • appears EP 0 lobbyist t1 E d?(n-(
nti (1
without special compensation • i orin for fltbt u_ vxirn54,?direct,indirect,5contingent,toC']J su••ortd a ro••ositiontt°
EItem diEffigailtityczah he ail eo re.uiredL:ffufti • a llnre•uiredm( 3?oi7re•istrationfi "
•
If:the principal is a:Corporation; Partnership or Trust, the following information MUST. be provided
ursuant to City Code Section 2-482(c "
n
. NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none;write N/A): /✓4Nf/L "t.- ina .wc�
• `.••"• NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY;.A 5%.OR MORE OWNERSHIP INTEREST.IN SUCH•
CORPORATION,PARTNERSHIP OR TRUST(if none,write N/A): kI '4' ✓ #4• e e/ /
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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 re uestfor proposal, invitation to bid, or public hearing number.
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IV.' ITY 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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Melner Com►ni ssioner-
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bay bayi Richardson :- Comr -ISS ioner"'
• 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): .•
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The following six(6)questions MUST be answered: • •
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1) • Pursuant to City Code Section 2-488,-entitled"Prohibited:.Campaign Contributions By Lobbyists.On Procurement Issues •
. . Yes_No: . . 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 Co_ de•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 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 Jerk 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 wiitnesses.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,-
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:
• Yes No: Are. you providing•.only scientific;'..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.compensation or reimbursement? - • - ` '
.
- .5) Pursuant'to City.Code Section-2-91(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 proVidect campaign.consulting services
• • within the past election cycle:See Section 2-491 for more information: •' •. '
. • Yes o: Have You provided campaign consulting services to an incumbent member of the_City Commission. :
within the past election cycle?If lies;please:list the incumbent members)of the City Commission: . '
•
. . ' Yes No: . -'If v[es�haslitibeen71ess7th 12TmonthsTsine'thTlectee-dTofficial(s')Tvirhm you provided campaiq .
• • consulting services was sworn irn T ' ..
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 publiarrieetinq:. :. .- - - •:
.. • • Yes �1 o: • ' Have.you'provided campaign consulting services to an incumbent member of.the-City Commission .
.T. • •within.the past election cycle?If:ves please list•the incumbent members)of the City Commission: :•.
•
•Yes o: ; • f yes, were you promised or did you receive economic consideration in exchange for campaiq
'consultin services? .;
• TO BE COMPLE CITY CLERK'S STAFF
TED.BYSTAFF ONLY..
:' • Annual Registration fee: [ ]Yes r?C]No Amount Paid$ �, MCR# D t`"(A si,1C. IMO Date Paid , ..
•
Lobbyist Registration Form received and verified by:
F:\CEEBWALIAaFORM3\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc Revised 03/11/2020 •
• - : Page 3 of 5., :. - : ' .. ..
VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR,EACH LOBBYIST SHALL SUBMIT TO THE OFFICE:OP 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 COMPENSATION DURING THE:.REPORTING PERIOD:1 :
Signature of Lobbyist: .. Date h :/67-Tim:
•
• 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'farniliar with the provisions contained in'Chapter 2; Art. VII,:Division::3, entitled "Lobbyists of
the Miami Beach City Code and all reporting requirements. :
•
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Date
Signature
of Lobbyist: ;. .. � �.. � � .. .. .
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Signature of Principal: Date �(
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VII. :NOTARY SIGNATURE AND SEAL: ;.
:.. . LOBBYIST PRINCIPAL •
State of :F1 Qr I State of• :Fl D ri,C�q
County of 1 ouiJQr[# County of gmt-Aj rl
Sworn to.(or aff�ir ed)and subscribed before me, : : :Sworn to(Or affJir�ed)and subscribed before me, '
by.means.of Vphysical`presence . by means of'L 'physical.presence :
or online notarization;:: or 0 online notarization,
this: I l b day of HQ.rcJ-1 2022 by :this I Ui day of I"le1.rGr\ '.. ' :2022.by .
D is 1 C. . •Mc r•;cin; ;e.l C I"I nc n : .
NAME:OF LOBBYIST: : NAME OF PRINCIPAL ..
Produced ID . : : _Produced ID. _ •
FORM OF IDENTIFICATION : FORM OF IDENTIFICATION :
Personally Known '.. PPersonally,Known •
l
; gnature of Notary Public- � �� - : • ignature of Notary Public
Name of N q ,�,,, Name of:Notary,Typed;Printed.or Stamped
,,Wip",,. JU TTE TALE :FEED :
�-Notary Public-State of Florida •
(NOTARY.$5 1 _'� P . Commission#GG•.934902: (NOTARY'SE' %, JULIETT
:` Y ETALE .
.. - .w,F ,4,�,� _ ,My Commission..Expires: - - =° P`�`�; to Florid
� 4��0",1„��. - .. � - � +_Notary Public-State of Florida � � �
January 31, 2024 Commission'#GG.934902
°•%R °� MyCommission Expires.. •
: ?The term"lobbyist"specifically:excludes:the following persons: . January 31, 2024 •
•
• Expert witnesses:who. Provide.only technical or other s ecialized information or testimon in.. ublicmeetin s;an : person who
P Y . .P Y� P 9 YP
only appears as a.representative of a neighborhood association without compensation or reimbursement for the appearances whether
direct;:indirect or contingent to ex ress support of or o p positionto anyitem;and anyerson'who.onl 'a p. pp pp ' p ,y ppears as'.a representative of -,. . .
not-for-profit community based organization'for the:purpose of requestinga grant without special.compensation'or:reimbursement for :'.:
the a.
ppearance. . .
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MIAMI BEACH . .
„ . . . .
City of Miami Beach; 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miarilibeachfl.gov
:.'Office of:th'e City Clerk: :'.. : : „ . .. : :
:Rafael E..Granade;City - : CityClerk@miamibeachfl.gov . -
Tel 3.05:673.7411,:Fax:305.673:7254:: : -
NAME OF LOBBYIST.:,_ 1706:.. .0 44 C fd✓/.
1) LOBBYIST FEE.EXPENDITURE AND:COMPENSATION STATEMENT
Pursuant to City Code. Section .2-485(d), the City Clerk shall notify any lobbyist (pr.
- 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 $5.0.00 a:day shall .be assessed for Statements filed after the
due date. The'.City:Clerk shall notify.the Miami-Dade County Commission on Ethics and
Public Trust of the failure of::a lobbyist :(or.principal) to file the Statement-or pay the:
assessed.fines after notification. .. • : .. • • .. :
Any lobbyist,.who fails to file the required Statement.by April.30th of each:year, shall be:
automatically.suspended from:lobbying until:all.fines.are:paid; unless the.fine has:been •
appealed to"the Miami-Dade:County Commission on Ethics and Public Trust. ': :.
hereby acknowledge that on. February.. 28.of each year,.I shall submit to the City Clerk a : :
signed Statement under oath listing :all lobbyist expenditures,: as well as:compensation
: received, for the:preceding calendar year with regard to the specific issue:on which I:have. :.
been engaged to.lobby.
.. : : 2) LOBBYIST WITHDRAWAL.. :..
Once an issue I:have registered to lobby.has: concluded :or I am no longer lobbying on
that issue, I shall immediately file a Notice::of Withdrawal with the Office'of the City Clerk.
3) ANNUAL LOBBYIST.REGISTRATION FEE:'
:understand annual registration of all lobbyists.shall be required for each 12-month period
:commencing :October .1 of each:year;;and.:the fee for:such annual _registration :shall. be • : :
500.00 pursuant to Section 2-482 Of the Miami Beach City Code.
re of•Lobbyist :
Signatu . •.Date
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F:\CLER$ALL1aFORMSILOBBYIST FORMS1Lobbyist Registration.Form Revised 03-11:20 REG.doo
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