Madeline Rodriguez Ortega - Everardo Chavez (2) & - vT
RECEIVED NOV 162022
WIAv (Office of the City Clerk
1700 Convention Center Drive CITY OF MIAMI BEACH
Miami Beach, FL 33139 OFFICE n=THE CITY CLERK
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 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 foreseeabty 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 infarrnation.
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 `We" 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 frle.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 fours shall be required for each principal represented on each specific issue.
I. LOBBYIST INFORMATION:
NAME OF LOBBYf (Last) (First) (Midrire Name)
PIMbickit,ravac 1M ecv1 Ave. Svi le2Pi }Mctw►( coc"n FL 3.3Sy-J
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
-lisp-34-g 0 i-&ci v+e_fAm dart VS
LOBBYIST BUSINESSIFLE€'HOIN E NUMBER CELLULAR TELEPHONE NUMBER EMA! -LADDRESS
•
II. PRINCIPAL INFORMATION: •
C-‘44 \or. e-y v-e,v-ard
NAME OF-PRINCIPAL (Last) (First) (Middle Name)
P V WsDiovirti ivy - 5001ki%s Av.e 5 tzo.i idativit $eac EL 33%9
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) Ma Cods)
DI-gcik 30c 3 S ev e v-og,. villa ` QS.
PRINCIPAL BUSINESS-TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
Puisuant to Citir rode Se:aibii•244az(h)(IXa):, any:'izbipplatioN Partnersnip,?or nttret'a:ra.weh®appeals 7s•a tebbAt On-beta:of!bat
e--i*y,v tout special or;reirriv-cserr>ei*for the;appearanc whethe ditett.;.indirii4 oci dr4Lngent.to express's oit at.or:14i0p;stinktd
an heir shalt rag . thetkeiclerii_as_requited.by tti«sairbaecttclt huh shal.nat tie reg Ired...pai any.reg atiorife
if the principal is a Corporation, Partnership or Trust, the following information MUST be provided
pursuant to City Code Section 2-482(c): {{ Q t
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write WA): C V ,Yt 0 Q vs,G L/e —
• 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): . N! f _ _
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HI. 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.
r reseva -F lov o \, %11 pv? QScc\ +a N‘e ‘apt B POi -t
COSNra\ 3 Coy(Aq`\ 6 srbnit `Pa ye c s
CO V Vet\ p rtse e Ce:1 010 c►\ Q i ek be IV Ail 1.14 i 1\
1 b1 ecxeS‘ 2t7a_
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 Narne of Individual and Contractual Relationship(if yes,explain) YES NO
Title of Person to.be Lobbied /
00„vi 13e *eu prat INAeV l ei\ %AMC 1/
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):
0
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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•stto o: 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 2-4490,entitled Prohibited Campaign Contributions By Lobbyists On(Real Estate Development
Issues
—Yeso: 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[tern,shall register with
the citycler t as required by this section,but shall not be required to pay any registration fees.
t�/.Yes 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 ally 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
noWor-profit community based organization for the purpose of requesting a grant without special compensation or
reimbuent for the appearance.
Yes ZNce Are you providing only scientific. technical or other specialized infomnation: appearing as a
representative of a neighborhood association without special compensation or reimbursement or
representing a not-for-profit based organization for the pumose of requesting a grant without
special compensation or reimbursement?
5) f lent to City Cede Section 2-491(1). no campaign consultant shall lobby the City Comtrtissien for a period of 12 Months
following the swearing hi of any erected ofac ial(s)for whom the campaign consultant provided campaign consulting services
'within thpast 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 ves,please list the incumbent members]of the City Commission: •
Yes,_No:• if yes -has tt ess been-1 than�12-m theonths-since elected-4f1ciai(sj.whom,yrou pravi�'carmpaign
onlsuitinq 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 town 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_E ose such particular
service bTore to bbyinn 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 members)of the City Commission:
Y—_Yes No: !fetes. were you'prom'edor-dld vac' receiVBecgpnomic=consiberation in'elxchanei for•campaignt
consulting senates?
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual R®gistraban tea ( ]Yes ]No AritoitPaid$ MCR,if =- r.`) '`�3tC Paid. .. . . -> - -
LobbyistRaglatration Femi.received andrrenfied by s
reel resett.tia s(SksoaB nvisT soesi3'{totse rtiaarationelen rtiesian2`rs-et:ed FtEGdac. - .,12a+rised 03�11 j2 -3 .
020-
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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 DURI THE REPORTING PERIOD.'
•
Signature� of Lobbyist y Date Wove w4a et- °S 202 Z
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 -ode and all reporting r uiremen r_
Signature of Lobbyist / Date 7 l I ct Z
Signature of Principal: Date Oil Za 2
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of P i-L v1 d a State of F(o tr 1.6 C" 4
County of: to`tTt�t1\ 9c4.d e County of: 'r� cx -(�
Sworn to(or affirmed)and subscribed/before me, Sworn to(or affirmed)and subscribed before me,
. by means o174-physical presence by means of>fphysical presence
or CI online-notarization, or 0 online notarization,
this c day of N G V.2v �i`Y 2O2' by this day of NI O ve vA lo.e.( .20_,by
tikatar21 V%e C,1 ,5 Eveitrc'do O_fincve ,
NAME OF LOBBYIST `j NAME OF PRINCIPAL
Y-Ptodticed iD F L �V e Y �-\CE'u se Y.-Produced ID F( )r�,vie ve- i e c
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
Pe it : :,. Pe wn
Signature of Notary 4ublic Signature of No ublic
&WON\ ala D. Pe`n cti amoS,Oka 3 p2\A C
Name of Notary,Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped
(NOTARY S • 01 AILPENA
*. - * Caoo fonfHi07f150 (NOTARY SEAL) pbfAIDAO.PBfl4
5 ' • R' Epresl at25,211x5 , Cairressi3nllHii071150
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The term"lobbyist"specifically rcxrtudes the following persons: T om tented Thu iYwltiia7k*Nie
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 far the purpose of requesting a grant without special compensation or reimbursement for
the appearance.
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MAMIBEACH
City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florid 33139,;wnv.miamibeoeh.i3.ggav
Office of the City Clerk
Rafael E.Granada,City Clerk CityClerkemiomibeachil.gcv
Tel:305.673.7'411,Fax;305.673.7254
NAME OF LOBBYIST: act Q\ i v`e. tkoa-st ve-s Otkla 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 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 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
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
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.
57/1" ' ..01°If 0 -
Sigrrture of Lobbyi / Date
F: lL'r.,FORICSE.OBEVIST FOR1a5 thtayEzz Rags:Mon Re=Raw-ad 03-11-2O REG.dae
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