Bernardo Fort-Brescia
Ii1.m IIoo;:dI
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-
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to enalUrage the passage, defeat
or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the
aty Manager or any city board or committee; or any action, decision or recommendation of any dty 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 tenn specifically Includes the
prindpal as well as any employee engaged in lobbying activities. 111. term -Lobbylsb- has specltlc u:dalons. P1_ refer
to Onlhane. ZOO43435.
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(First)
-. :If 200
( ty)
~()S. 372.*'75'
FAX NUMBER:
L LOBBYIST RETAINED BV:
//fL.Jp'Ci~"M.aWl
NAME OF PRINCIPAl./CUENT.
. LJL.
.
II V,,- ,
BUSINESS NAME AND
3u$. 612. SJ5'~
TELEPHONE NUMBER:
/AlP It SOli M,4i6f;
(Number and Street) (City)
3,$. 672. 5?."
FAX NUMBER: (Optional)
(Zip Code)
EMAIL: (Optional)
Fill out this ..ctlon If prlndplllsl Corporstlon, Plrtnershlp or Trust [5ectIIIa2 (e))
. NAME OF CHIEF OFACER, PARTNER, OR BENEFICIARY: A/~~.sA~f) Fe4A.e/f,'
. IDENTIFY All PERSONS HOLDING, DIRECTlY OR INDIRECTlY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: lIk$s"A4'".o ~IlJU.fI,', MAl/lt,i'ZlD (},lMhc.,'
n. SPECIFIC LOBBV ISSUE:
Issue to be e~~ detail):
DI. CITY AGENCIE5/INDMDUALS TO BE IDlED:
/
A) Full Neme of Indlvlduel/T1t1e
B) Any Flnende', Femmel or Profe..lon.letlonshlp
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETItDIRLY,
FLAT RATE OR OTHER) :
.
A) LOBBYIST DISCLOSURE: (Required)
,v,~(
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Require".
NoNl'"
Yes ~ ~ ~~~ feDresentlnG a nalol'-Droftt corDOl'lItl. or entity without saeclal comaenAtlolTo
_bu _I!I ~_' Pursuant to Ordinance No. 20043435.
1)
Pursuant to Ordinance No.200.3393 Amendina Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
camoaian Contributions Bv Lobbvists On Procurement Issues":
,/ "
Yes I U
\
~~::~ 10b~:tn~ =n~~ ~~ ~ Goods. eaulament or services. or on a aresent
or aendlnG award tor Goods. eaulamenlr service?
2)
Pursuant to Ordinance No 200.3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5
thereof Entitled "camoaign Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
camoaian Contributions Bv Lobbyists On Real Estate Development Issues":
Yes
\j
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V. SIGNATURE UNDER OKH:
ON OCTOBER fT OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITUI\EN WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEA. STATEMENT
SHALL BE FILED EVEN IF THERBtAVE BEEN NO EXPENIrTURES OR COMPENSAlIlN DURING THE
REPORTING PERIOD. (J-;/P? ~
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting
requirements. /J 8
Signature of Lobbyist: I ~
Signature of Principal/Client: ~
VI. LOBBYIST IDENTIFICATION:/' PRlNCIPALmENTlFlCATlON:
Produced ID
Produced ID
Form of Identification
Form of Identification
Personally known (lobbyist)
~
Personally known (Prlnclplll)
..
VII. SIGNATURE AND STAMP OF NOTARY:
Signature of Public Notary - State of Florida
NotBrlzatlon of Lobbyist's signllte
~ o.m.n. .......
*..* IftCamlnllelon~..
\:.:.Y ~ September 10.2OlI4
~
.. MOHIEDDIAN D. ZARIF
~ 11 MY COMMISSION" 00294039
~Of",." EXPIRES: Febr"''Y~.2008
Annual Registration fee: [vrYes[ ]No A~~:~~E S 0~~:#~1tiJ3t/3 Date Paid -5"-1/,051
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F: CLER R!A-M\LOBBYIST\LOBBYIST FORM 04