HomeMy WebLinkAboutRoberto Datorre City of Miami ~ach ~ce of the CiN~
17O0 Convention Center Drive, Miami ~L 3~m~
LOBBYIST REGIST~TION F~
Lobbyist means all persons employed or retained, whether paid or not, by a pdndpal who seeks to encourage the passage, defeat
or modification of any ordinance, resolution, action or decision of any commissioner; any action, derision, recommendation of the
City Manager or any city board or committee; or any action, dedsion or recommendation of any city personnel defined in any
manner in this section, 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 ~Lobbyists" has specific exclusions. Please refer
to Ordinance 2004-3435.
NAME OF LOBBYIST: (Last) (First)
BUSINESS NAME AND ADDRESS (Numb~and Street) (C~)
TELEPHONE NUMBER: F~ NUMBER:
I. LOBBYIST RETAINED BY:
(M.I)
(State) (Zip Code)
NAME OF PRINCIPAL/CLIENT:
BUSINESS NAME AND ADDRESS (Number and Street) (Oty) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
· NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
TT. SPECIFIC LOBBY ISSUE:
Issue to be lobbied (Describe in detail): ~
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/lltle B) Any Financial, Familial or Professional Relationship
/V. DZSCLOSURE OF TERMS AND AIqOUNTS OF LOBBY/Sr COt4PENSAT/ON (DZSCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)jh~/A
m P mC ,AL'S D SCLOSURE O B¥ S'r
No: Are you representinq a not-for-profit corporation or entity without special compensation or
reimbursement. Pursuant to Ordinance No. 2004-3435.
Yes
1)
Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Campaiqn Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camppign Contributions By Lobbyists On Procurement Issues":
Are ;)resent Dendina bid for aoods, eaui;)ment or services, or on a ;)resent
you
10bbyina
on
a
or
or I~ndinq award for eoods, euuiDment or service?
2)
Pursuant to Ordinance No. 2003-3395 Amendino Miami Beach Cit~ Code ChaDter 2. Artide VII Division 5
thereof Entitled "CamoaiQn Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
C. gmpaiQn Contributions Bv Lobbyists On Real Estate Develoornent Tssues":
Are you Iobbyinq on a pendinq application for a Development Aareement with the Citv or
applicat;ion for chanae of zonin;) ma;) desianaUon or chanae to the City's Future Land Use Ma;)?
V. SZGNATURE UNDER OATH:
ON OCTOBER IsT OF EACH YEAR~ EACH LoBBYiST SHALL SUBMTF TO THE CTFY CLERK A Si'GNED
STATEMENT UNDER OATH~ L~i~.NG LOBBYING EXPENDZTURES~ AS WELL AS COMPENSATION
RECEIVED, TN THE C~I'( OF M~A, MT BEACH FOR THE PRECEDtNG CALENDAR YEAR. A STATEMENT
SHALL BE F~LED EVEN ZF THERE HAVE BEEN NO D~JR~NG THE
REPORTING PER~OD.
~g~fl'ature of Lobbyist
! do solemnly swear that all of the foregoing facts are tru/e and correct and that ! have read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting
requirements, ~
Signature of Lobbyist:
Signature of Principal/Client:
LOBBY/ST ZDENT[FZCA1/ON:
PR/NC/PAL ZDENTZF~CATLON:
Produced ID
Form of Identification
b,~ersonally known (Lobbyist)
Produced ID
Form of Identification
Personally known (Principal)
VZI'. SZGNATURE AND STAMP OF NOTARY:
State ~L~;~n'da, County of Miami-Dade
Sworfl_to ar'~sc]b~'iqt~ be,f~e me ~
---SCgnat'l:r~e.~ Pul~lic Nota~ State of Florida
Notarization of Lobbyist's signature
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This __day of ,20__
Signature of Public Notary - State of Florida
Notarization of Principal's signature
/ FOR CLERK'S USE ONLY
Annual Registration fee: [ ] Yes [ ~.~]j"No Amo, J~nt Paid/) MCR # .Date Paid
Lobbyist Registration Form received and verified by: ~/~---
Revised 02/10/04 F: CLER\AL~MAR[A-M\LOBBYIST~LOBBY]ST FORM 04