W. Tucker Gibbs - Sarah Wright305 673.7411 . Q ry OF MiAM► BEACH
LOBBYIST REGISTRATION FORM OFFICE OF THE CITY CLERK
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, dedsion 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 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 answer, use a separate sheet(s) of paper. If you have nothing to report in a particular
section, you must write "none" or 'Wa" 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 principal represented on each specific issue.
I. LOBBYIST INFORMATION:
cK ea
NAME OF LOBBYIST (Last) (First) (Middle Name)
UW.VGKC CotaRs0 P, 11. aR&C L2 11;A car U6DAJ0rGWr= , j L, 331133
LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
&614 .k- W&dDs-78k-27zo fycker9 w ►lobe cows
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
II. PRINCIPAL INFORMATION:
IA] R I G kT 56dn 14
NAME OF PRINCIPAL (Last) (First) (Middle Name)
I+-430 L4-Wjb� L%E141E Aaln&% 42icAL1A I%L. .-3139
PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER ENTA&JADDRESS
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided
pursuant to City Code Section 2-482(c): O/A
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY (if none, write NIA):
NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR �MYORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST (if none, write NIA): 1�/
Page 1 of 5
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 Name of Individual and
Title of Person to be Lobbied`
Contractual Relationship (if yes, explain)
YES
NO
ml�srn e
I+P& l4pAai"
PLAWL b
CAN krm 7
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):
/Ix - -
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):
HSLD1 hr
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":
_ Yes VNo: Are you lobbvina on a present or pending bid for goods equipment or services or on a present or
ON:Rending 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 �( No: Are you lobbying on a pending application for a Development Agreement with the City or application
iT 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 clerk as required by this section, but shall not be required to pay any registration fees.
_Yes YNo: Are you representing a not -for -profit corporation or entity without special compensation or
I 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
reimbursement for the appearance.
_Yes )( No: Are you providing only scientific, technical or other specialized information; appearing as a
TC 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 past election cycle. See Section 2-491 for more information.
_ Yes XNo: Have you provided campaign consulting services to an incumbent member of the City Commission
TT�` within the past election cycle? If yes, please list the incumbent member(s) of the City Commission_:
Yes No: i. as
I+atedoff� l .ou rro' "a
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 public meeting.
_ Yes XNo: 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:
Yes No:
_ tJfA
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual'RegistntOon fee. ; j j Yoe [ j No Amount Raid_$ MCR# Date Paid
Lobbylst>RegistrationrForm recelved,arrd<vsrNied by:
P:\CLEKk$ALL\aFORMS\LOBBYIST FORMS\Lobbyist'Registration Form Revised 03-11-20 REG.doc Revised 03/11/2020
Page 3 of 5
VI. SIGNATURES UNDER OATH:
Signature of Lobbyist:�e Date i! q
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 and all reporting requirements..
Signature of Lobbyist: Date
Si nature of Principal: Date q
VII NOTARY SIGNATURE AND SEAL:
LOBBYIST:
State of
County of: M%AV-,',
Sworn to (or a� ffi�d) and subscribed before me,
by means of 1 'physical presence
or ❑ online notarization,
this I_ day of Seto j ,%r 20Z3 by
ICJ f JjtAcke,_- G .3b 5
NAME OF LOBBYIST
_Produced ID
FORM OF IDENTIFICATION
V Personally Kwwn
Signs of Notary Public
A r C U' (et to �- .
Name of Notary, Typed, Printed or Stamped
YPRINCIPAL
State of FI 0ey-4\
County of i Q 1-k_ �
Sworn to (or affirmed) and subscribed before me,
by means of [I physical presence
or ❑ online notarization,
this �L day of 20Z by
NAME OF PRINCIPAL "
/Produced ID Nac: (V+ ,
FORM OF IDENTIFICATION
Personally Known
4LV42
Signature of Notary Public
r
414 4� V\ kaCA
Name of Notary, Typed, Printed or Stampe
(NOTARY SEA 'PATRICK D. CAMM (NOTARY SEAL)
MY COMMISSION # HH 26WO
EXPIRES:Apri119,2026 1 Notary Public State of Florida
7 ,+� a� Martha Rodriguez
IIII My Commission HH 283355
'The term "lobbyist" sp if y excludes the following persons: Expires 7/4�2o2s
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.
Page 4 of 5
MIMA I 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 Clerk
Tel: 305.673.741 1, Fax: 305.673.7254
CityClerk@miamibeachfl.gov
1) LOBBYST GALE 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.
)) �'
Signature of Lobbyi
1 /03
Date
FACLER\$ WaFORMS\LOBBYIST FORMSTobbylst Registration Form Revised 03-11-20 REG.doc
Page 5 of 5
MBF
City Hall
1700 Convention Center Or.
Miami Beach , FL 33139
305-673-7420
Welcome
005891-0014 Adrian V, 01/09/2023 02:39PM
MISCELLANEOUS
Reference 1: MCR430946
MCR OPEN (MCR)
2023 Item: MCR
1 9 850.00
MCR OPEN (MCR) 850.00
---------------
850.00
Subtotal
Total 950.04
850.00
CHECK 850.00
Check Number007624
------- ------
Change due
0.00
Paid by: W. TUCKER GIBBS, P,A,
�k'^ 7114
Thank you for your payment
CUSTOMER COPY
o
N
a
0
M
O
z
v�
Q.
Gi
U
•= Q
W
U Co
V C
O Q
_
LL
Q> O
U
0
L,
x
W
co
41
a�
0
0
W
H
W
J
a
2
O
U
�
d
W
co
m
o
v~i
o
O
O
N_
m
CD
z
CD
N
o
�-
i,
N
>
U
U
E
3
U
O
I
Q�
o
i
N
0
i
z
N
E
=
a)
a
W
Q
M
N
N
E
U
U-
N
4n
Q
d
m
U
2
o
1E
a