Michael Fischer - Daniel C. Mancini oq,-,4i3; d o 1 b- 050-k,
. .: . .: . . . .
oi�
. - 1 _K
ED •
AR 2
i\AA1V\
M 29 022
.I I EIAC Office of the City Clerk
TY
1700 Convention Center Drive cIp��
Miami Beach, FL 33139 OPP C8 OFT.AM B CA H
305.673:7411
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_cornmittee;or any action;.decision orrecommendation 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 answerr, 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 re also sought to be lobbied shall require that the lobbyist filean 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 registration fomis shall be required for each principal.represented,on each specificissue.-
I.: LOBBYIST INFORMATION:
FT- Pr'; ►ch ( coo)
•
NAME OF LOBBYIST (Last). (First) (Middle Name) . •
DeerFi e d
• R t c t'�1•an Cr In S-t rt c-E-iC n L .'.I r�,C '21([-):: Bezich,
• :LOBBYIST BUSINESS NAME AND ADDRESS (Number and,Street) . (City) (State) • (Zip Code)3
(95Zi :4216 7'1221' : C �70? ".7.3 -.171-] 1 I 1 F'►Scker( R1c-.Mar%FL.con
>
LOBBYIST BUSINESS TELEPHONE NUMBER • . ' .' .. CELLULAR TELEPHONE NUMBER :- EMAIL ADDRESS
: II. PRINCIPAL.INFORMATION: . • =
M , • ris � . her c ' •
:NAME OF PRINCIPAL :(Last) • (First):. ` : 1 (Middle Name) •
•
' R►C Mare Chinciruc+ir�rn FL)-Inc I�c�`& IS S i-remit, _I r-veld--B'adh s FL
• PRINCIPAL BUSINESS NAME AND ADDRESS :- (Number and Street) .. (City) (State) (Zip Code) 3511 2
•
( 4.2i4 =I221 (.g54). 'bfnnanCini.0 R►G-Mnr\FL.Corr
PRI CIPAL BUSINESS TELEPHONE NUMBER • CELLULAR TELEPHONE NUMBER-
- EMAIL ADDRESS
, PROEM tb C1f ••- Section 2-482(h)(1)a):A principal CilE1:0 corporation, partnership,®'€fl 21'a 1 •.p-, lobbyist pt ti f
without special Cp rei .ursement for MB tJ 1.i iiit1.2a.C: direct,indirect,l7?contingent,Co ex•ress1.1001.o.s osition(
hill- di re•ister C' n (gla mre•uired b t&fb i dnt:111 G f7D re.uired Qr)1:,t+/ y re•istration fima •
: If the . principal is a Corporation, Partnership or Trust, the following information MUST be 'provided
• ' pUteuant to city Code Section'2-482 c
• NAME OF'CHIEF OFFICER,:PARTNER,OR BENEFICIARY(if none,write N/A): [XCfniel C.. Hanel t n i
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): cchIAJ c. rci ft • Mar-NCIr\i •
•
•
Page 1 of 5
. . ice•
•
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.
Ikiec+ Ave. 7 N0 -h De 2b 1 -- o q ► '- k-
1 es-f- Aye. -. :SL u4-h a 2OIt =.dqo ►Le,
I.ndre r Creei_ o:1.1- - ?bier:.. I-'k.1?)
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 presentdate,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
DCln CIe1b - - h'Io, pr :
r i s :ri G on2j lP Z. Ccrr)rn S i oho r- Rrinec u r\c er Con+rQc-/
Mar scuroue1iQn CpmrniSSipryer LOi c ' 1117..
. - . .. .
�I-E'_x� r rncu-Y��z cnmml s�,��r,�r� �c.�o�e�-.
54every Heiner— Cori-,rniSS;Or i— . . .
gic;►. rr►oIQ COri-v-ross or;e�-
.Day i
Pursuant to CityCode Section .2-482(g), every registrant shall e required to:state:the e 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 Relationships or other relationship giving rise to.an:
a earance.of Impropriety
Pp :(if none,write N/A): :
i .
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):
N DnF'
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":
ur
`� 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 Code Section 2;490, entitled"Prohibited Campaign'Contributions By Lobbyists On Real Estate Development
Issues":
—Yes J•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 Cities 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 orindirect to express support of or opposition to:anyitem,shall register with •
• the city clerk as required by this section,but shall not be required to pay any registration fees:
•Yes..J 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,'
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. '
reimburs .ent 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=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 st.election cycle See Section 2-491 for more information. - -. •
Yes No: 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 members)of the CitY Commission:
Yes_No: :If yes, has it been less than 12 months since the elected official(s) whom you provided campaiq
' • consulting services was sworn in . •. .. '
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 b re lobbying the.City Commission at a public meeting.. : • • _ • : .
Yes No: • 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: •
If yes, were you' Yes.�N•o•: promised or did you receive economic consideration in exchange for campaiq
" •consulting servicesi..- - •'
• TO BE �r,,n �I
COMPLETED 'BY CITY CLERK'S STAFF.ONLY.
Annual Registration fee: [ ]Yes[ No Amount Paid$ MCR iF Date Paid
Lobb yistby:Registration Form received and verified S
Y
Fe\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc Revised 03/11/2020 •
. : Page3of5_.
•
•
VI. SIGNATURES UNDER OATH:
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"COMPENS' TIO D RING THE".REPORTING PERIOD:1 -
:. Signature of•Lobbyist c ; Date 3 l
•,
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 Cod and7I re iting requirements. : : : :
Signature of L ist: �/obb : .Date
• y .1 l0
:Signature Of Principal: Date 3 I I l0 12ti"Z 2
VII. NOTARY SIGNATURE AND SEAL: : .:
LOBBYIST: PRINCIPAL
-: State of :flc r i d . ._: State of. I`f o r i d o,. :.:
County of: P r t,ti Et,f t' • • County..of vo
Sworn to.(or affjrmed)-and subscribed:before me, :Sworn to(Or affirmed)and subscribed before me,
by means.of KphysiCallpresence - : by means IiiihysiCalpresence:" :
or.0"online notarizationy": - •or0:online notarization
-
this: Ito " day"pl.�Q1'l`�'. . 2022.,'by ' " this -Ito day.of.M(Irr'h' .. : .,20? -by: . "
M i Ch I R . i crkP r• Dar;;e1• C.:C . .M get nc��;�. .. •
NAME:OF LOBBYIST: :. • .NAME OF PRINCIPAL "
Produced.ID _Produced ID
FORM OF IDENTIFICATION " FORM OF IDENTIFICATION
•
/ " • " personally Known
• • - f. Personally Known '-- - '
A7E-Thal4( 1 L W Th:ate-, . .
i nature of NotaryPublic'g - • signature of Notary Public �" • : •
Ll". ,TcL.l en - Le-Hen
....,�._ ... Notary,Typed, Printed of No -•• .. :�. . Name of Nota ype or Stamped
o�""�°1B, ULI TT E ALEN FELD
J E T T N
Notary Public-State of
• . •" (NOTARYS. - • (NOTARY' JULIETT TALENFf 1,D
II mm'issiori # GG 934902"" tP
Co
I I „a; M � ��;Notary'Public State of Florida
.rdi r -
eoFFo," Y Commy 31-, 02pires ._ Commission # GG:934902.
•:-. January 31: 2024 . . =a.
•
-.%.'I j �oMy
i Pc :Commission.Expires
.• 'The term"lobbyist"specifically excludes the following persons: " •January 31,•2Q24:-
Expeit 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 indirect or contingent to"express support of or opposition to any item;and any person:who.only•a 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 BEACH
. .
City of Miami Beach, 1700.Convention Center Drive-,Miami Beach,Florida.33139,www.miamibeachfl.gov
Office of the City Clerk; :'.. : : : ..
Rafael E.Granado;City CityClerk@rriiamibeachfl.gov
Tel 3.05,673.7411,Fax'.305.673:7254:. =
' h
NAME OF LOBBYIST: M C' r
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:Ex enditure 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.
: 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
:: reCei ved, 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:.
I.understand annual-registration of:all lobbyists shall be required for each 12-month period
commencing :October 1 of each:year, and. theTfee for such annual.registration_shall be :
$500.00 ursuan o Section: -482:of the Miami Beach.City Code.
11 -A, •
Signature of Lobbyist :. .. Date
Fi1CLERISALL1aFORMSILOBBYIST FORMS1Lobbyist Registration Form Revised 03-11-20 REG.doc ..
., . Page 5 of 5,