Jessica Lynn Munch-Diltmar - Jessica Lynn Munch-Diltmar r___ ,r"- .---. ..--,-.--- , '.--* •
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RECEIVED
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Office of the City Clerk
1700 dornientIOn Center Drive . •
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'Miami Beach, FL 33139 AMI BEACH
, P.• . , 305.673:7411 . ca:00:FmT1H1:ZcOt Za
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LOBBYIST REGISTRATION FORM
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Lobbyist means all persons emPloyed.or'retained,whether paid or not, by'a principal who seeks to encourage the passage,a:e,GdLefeeRakt or .
Modification of any ordinance, reeolution, action or decision of any commissioner:,any action, decision recommendation of the City
, Manager or any City board or'committee;or any action,decisLon orseCommendation 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
ectivities.The term Lobbyist"has specific exclusions. Please refer,to City Code Chapter 2,ArticieN11,,Division 3, entitled"Lobbyists,"
tor,additional information. ," - ft i I . , , I , . 1, :l 1 :,, i , , ; , 1•4 1
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' 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 ariswer, use a separate'sheet(s)of paper. If you have nothing to report in a particular
sectiOn, 'y jou 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 filed throughout the period that the lobbying occurs.
Separate registration forms shall be required for each principalrepresented on each specific issue. P
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I. LOPBYIST INFORMATION:
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, . 'PI 1.40 611-:Dill-mae &,si cio- 1,-in n :
NAME OF LO,BBYiSr (Last) . • ., (First) (Middlel Jame)
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In1140 'Si Lttn SV1 iTAL '4-'- 01-9 i kl:e. an 1 r F1, 3 1443
LQBBYIST BUSINESS t,r A D ADDRESS
, (Number and Street) , (City) (State) , (Zip Code)
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30S-1PU21--(lb Uel ' ' . TDS7-9 si-wenpw ,i)imid)c)-voi.1-114v-I-eq
' LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE MBER EMAIL ADDRESS, . c8cirt9s .. 012j .
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' 'II. PRINCIPAL INFORMATION: • . . ".
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NAME OF PRINCIPAL (Last) (FitSt) • , ,.........(›le-tkrarne)
Sarne A'S 1%,.0 ILL
PRINCIPAL'BUSINESS NAME AND ADDRESS (Number and Street) • (City) (State) (Zip Code)
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i 'F,?RINCIPAL EtUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
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PursuantZ)(631 Vide Sect on 2 •82(h(lig)::A'priricTil"e•Car Corporation,pa ership,Cini e OM TAD-ape. -4!)6-8t ftibWist Ciii)tient or trid
entity •eclat compensation Ci retrnb rse en forg0,ap ea a ce'VaaaitatErb inch ect,C:gcnilicaa(t)expres_s .pst o,,,or op oon to
ellirerp spell re!istar4 the Cle ',as reguired by tills:subsectio butghall not be,eq irad t.pay-ny rgistration fess, .
If the 'Iprincipal is a Corporation, Partnership or Trust,the following information MUST be provided
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•Fiyi*Orit,:to City Code Section 2,482(c):
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• NAME OF CHIEF OFFIcpk, A PARTNER,OR BENEFICIARY,(if none,write NIA): , IN-/
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• • { + f .0 NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR ORE OWNERSHIP INTEREST IN SUCH
A i leil ?c".i.RispiRATION,•PARTINERSHIP'OR TRUST(if none,'write N/A): _ , 1 i i 1
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III. ISSUE TO BE'LOBBIED:
.. Describe with as much detail as is practical, including but not•-llmited•to'a specific description where
applicable of a pending,request for proposal, invitation to bid, or public hearing number..
4€-L2a_10' (IDS
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 mature of the subject contractual relationship.
Full Name of Individual and Contractual Relationship(If yes,explain) YES No
Title of Person to be Lobbied
t,c>Q:Q4-0Leat. K (alit') b.
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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 NIA):. .
V. DISCLOSE,RATE AND AMOUNT OF LOBBYIST COMPENSATION —Be Specific. (Note that a
contingency fee is prohibited pursuant to City Code Sec. 2-4`85.3): •
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The-following'six.-(6):questions MUST`be,answerede. •
1)' Pursuaritt.to"City Code:Section2-488;;entitled°Prohibited';Campaign Contributions By Lobbyists On Procurement,Issues":
. c . • Yes o: Are:vou'lobbying on a:.present or pending•bid`.for goods, equipment or'services,,orAon a-present or
pending awardffor goods,equipment•orservice? ,
2)' v Pursuant•to City Code Section 2r490 entitled Prohibited Campaign/Contributions By Lobbyists Qn Real Estate Development
Issues - 4 4. l' , 1,, '. 't'�.�°I , - . .
YessNo. ' .Are you`.lobbying•on!a pending application foria Development Agreement with.the.Cityiorapplication'
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for change•ofzoning=map designationor change•tothe City's.Future Land Use Map?
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' 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 express support of or opposition to anyltem,'shall register with
the city clerk;as required by this section,'but shall not be'required to'�pay any.registration fees: '
xYes_No: Are: you .representing a -.corporation.not4or-profit or ,entity without .special compensation or
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.reimbursement? - •
4) Pursuant to-'City Code Section 2-481, the, 'term-"iobbyist"specifically excludes,the following persons: Expert witnesses who
- provide pnly 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 reirribursement 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. •
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. ' • Yes No: Are :you providing only.:scientific;- technical or Lother..specialized. information;-appearing as a
•• representative of a-neighborhood'association without special'compensation or reimbursement•.or
1 .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 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 yes,please'listthe incumbent members)of the•'City Commission:
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'0, ''''.il ' ' _ . ' . . :
,. " ' !Yes_No
i ' i yes: as it been less than 2 month since the elected oftibial( w om vo pro ided campaign. ,
coitinq ser:vi'aes wasYs orn in? -__—__;____-_-.._— - _-_—-_— -__-_ - _ _ .
), 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 CityCommission,which lobbying icibbying activity•is'not otherwise rohibited b Code section
- 2-491) shall disclose'such'particular service.'on his/her lobbyist registration form and shall orally disclose such particular
' , service beforelobbying the ICity Commission at'a public:Meeting.—, , '
_YesXNo: Have•.you'provided campaign consulting services toian incumbent member of the City.Commission
'within the,pasteleetion�cycle?Ifyes,please list theancumberit.me�rnber(s1 of the.City Commission:
Yes_No: II yes, were-vo p.omised or id yo receive econo is canticle on in exchange!fo• cam•akin
eo"n uiftnq service 7 �_ _^ _ �__--
- , . - TO,BE COMPLETED.BY CITY CLERK'S STAFF ONLY''
, - Amount?aldf$ _ IMCR1# kv� I-_ _ _L rDa -—•-•di ✓ ____�
nnuaoRegistrationkTee i[i AlYes=[ __._ ,7..:::_w_.
'<.Lobbyist1Reg'istrationiFortIreceived and:verified=by •* ." -
FrSCterAN$'ALL\wF.ORt4S LOBBYISPFORrr1s.\Lahibyitt_Registrat(on_Form•Rev,sed 0391.120REG.Joc_ -_ . 1Reviseik(15111/,2020__
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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 COMPENSATION DURING THERE ORTING PERIOD.'
Signature of Lob yis. )I Date I I / ( 2 1 (/2
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 'a port' requirement .
Signature o Lob • Date I I Ii Z 1 0-0/ f
Signature Principal Date i( I I Z /20
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of (1-- State of
County of://4j (-0 County of:P///f/44/--1 /��e—
Sworn to(or affirmed)and subscribed before me, Sworn to(or affirmed)and subscribed before me,
by means of Q physical presence by means of Elf physical presence
or 0 online notarization, or 0 online notarization,
this /2 ` day of w o✓(—'rite 2, ,207?by this /Z day of A/O VCA-11/(_.7Z ,20g-by
E96fL.Y&A)PO/WO/ 1/7 r1/z ?551614• 4--YAM) 11/Uc /(—/JJ77-M
'NAME OF LOBBYIST NAME OF PRINCIPAL
Produced ID Tz— Di---- Produced ID Ft-- �L--
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
Personall K wn _Perrsonally Known
V NotaryC
Signature of Notary Public Signature Public
M/ /' Z2 G .00A7-oO►�z Of4fuJ) 2- L`ice ). E'2 .
Name of Notary,Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped
(NOTARY SEAL) or7 MICHAEL C.FERNANDEZ (NOTARY SEAL) __—
W MY COMMISSION#HH067574
,,,,,,,, MICHAEL C.FERNANDF
EXPIRES:NDV 30,20244T, MY COMMISSION#HH067574
` Bonded through 1st State Insurance
EXPIRES:NOV 30,2024
'The term"lobbyist'specific-ally excludes the tollowrng persons: °"_ ' Bonded through 1st State Insurance
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 reimbursement for
the appearance.
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MIAMIBEACH
City of Miami beach,1700 Convention Center Drive,Miortillieadh,Fiorlda 33139,www.miomibeachil,gov
Office Of the city Clerk
Rafael E.Granado,City Clerk CitYClerk@miamibeachfl.gov
Tel:305.673.7411, Fax: 305.673.7254
NAME OF LOBBYIST: IC -
4(Ana-) .--t)i
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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 Lobbyiet 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 $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 Ethic's 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
received,for the preceding calendar year with regard to the specific issue on which I have
been engaged to lobby.
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2) LOBBYIST WITHDRAWAL
Once an issue 1 have"registered to lobby haS tonclUded or 1 am no longer lobbying on
that issue, I shall immediately file a Notice of Withdtawal:with The.Office of the:City Clerk.
3) ANNUAL LOBBYIST REGISTRATION FEE
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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 orsbant to SeCtion 2-482.of the Miami Beach City Code.
4451:711763'
• bate
0
_ attire o Lobbyist
•:l.cl.EIRISALLtaF0RfASU.08BYisT,FORMSILobbylst RegistratIonforinR,v1sed,03-11-pREG doc'
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