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2024 Lobbyist Registration Form - CMB Code of Ordinances Section 90 Solid Waste (Adriana Davis) �nt3 aad� �f , ordcno.r�l.� so � : � wosie, Scc� �o�. 9a - :�ECE!�L'� Office of the City Clerk OCT 11 2024 1700 Convention Center Drive Miami Beach, FL 33139 CIN OF MIAM� �E�Ff�W 305.673J411 OFFIC� r� '� �, .. ""�G`�Ax L086YIST REGISTRATION FORM Lobbyist means a11 persons employetl or reNaineq whether paid or not, by a Dnncipal who seeks to encourege the passage, tlefeffi w motlifintion of any orGinance, resolution, action or decision of any commissioner; any action, dedsion, recommendation of ihe City Mana9er or any Ciry board or committee; or any action,dedsion or rewmmendation of any City personnel tluring the time penotl of the entire decision-making process on such action, tledsion or recommendafion tha[ toresceably will be heard or reviewe0 by Ne Ciry Commission, or a City hoard or committee. The term specifically inGutles Me O�ncipal as well as any employee engaged in lobbying activities. The term "LobbyiSY has specific exdusions. Pleau iefer to City Code Chapter 2, ArtiGe VII, DiNaion 3, entlded 'Lobbyists,' fo�atlditional inFormation. Inatructiore: Please complete all sec[ions of ihis fortn and submit the wmpleted fortn,with Me aDPlicable ke, to the Office of the Ciry Clerk. If you need more space to complete an answer, uu a separete s�eet(s) of paper. I(you have nothing to report in a parfiwlar section, you must wnte 'none' or "Na in that section. My charge to any information onginally filed, or any additional City Commissioner or personnel who are also sougOt to be lobbied shall require ihat Ne IoDbyist file an amendme�rt to ihe registration form. The lobbyist has a contlnuing dury to suppty intormation anU amend the kims filed Mroughout the penod t�a[the lobbying occurs. Separate registretion forms shall be requiretl for each pnncipal represented on each speufic issue. I. LOBBYIST INFORMATION: NAME OF LOBBVIST (Lest) (FlrsQ (Mitltlle Name) LOBBYIST BUSINESS NAME AN�ADDRESS (Number aM StreM) (Ciry) (State) (Zip Catle) LOBBVISTBUSINESSTELEPHONENUMBER CELLULARTELEPHONENUMBER EMAILAODRESS II. PRINCIPAL INFORMATION: NAMEOFPRINCIPAL (Lasl) (Firs�) (MiOdleName) PRINCIPALBUSINESSNAMEANDA��RESS (NumberantlSVeet) (City) (Sla�e) (ZipCoOe) PRINCIPAL BUSINESS TELEPHONE NUMBEft CELLULAft tELEPHONE NUMBER EMAII AD�RESS Pursuan�ro Ciry CoOe Section 2-082(h)(1)(a): A pnnd0al of any coryoretioq patlnership, or ather¢ntity who appEars as a IOEbyist on behalf of[ha� entiry,vn�hout speual compensation or reimbursemen�fa the appearance,wheUer tlirect,intlirecl,or wntingmt,lo expreu suppotl of or opposition to an item shall registei wilh�he CIeM as requiretl by ihis sutseclion OW sM1all nM be requiretl to pay arry regisl2�ion fees. If the principal is a Corporation, Partnership or Trust, the following information MUST be provided puwuant to City Code Section 2-482(c): • NAME Of CHIEF OFFICER,PARTNER,OR BENEFICIARY(it none,wrlte WA�: • NAME OF ALL PERSONS HOLDING,DIRECTLV OR INDIRECTLV,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,PARTNERSHIP OR TRUST(if none,vrtite WA�: Page 7 of 5 � III. ISSUE TO BE LOBBIED: Describe with as much detail as is practfeal, inoluding but not limited to a specific descriptlon where applicable of a pending request for proposal, Invitation to bid, or public hearing number. IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(a)(4), Ilst the City Commissioner or Cky personnel sought to be lobbled, and whether the lobbyist has entered into any contraetual relationship (paid or unpaid) wkh sald 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 Contractual Relationship(If yes,ezplain) YES NO Title of Person to be Lobbied Pursuant to City Cotle Section 2462(g), every registrant shall be required to state the extent of any business, financial, familial or professional relationship, or other relatlonship giving rise to an appearence of an impropriety, with any current City Commissioner or City personnel who is sought to be lobbied as identNied on the lobbyist registration form ffled. List any Businesa, Financial, Familial or Pro(essional Relatlonship, or other relationship giving riae to an a eannce of im ro r7e if nona write NIA : V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Soecific. (Note that a contingency fee is prohibited pursuant to City Code Sec. 2-485.3): Page 2 of 5 The following six(6)questlons MUST be areweretl: 1) Pursuant to City Cade Sectlon 2-488,entltled"PmhibiteG Campeign ConMbutions By Lobbyists On Procurement Issues'�. _Vea_No: Are I bbvi a on a oresent o e al bitl for aootls ea 'om t Ices or on o t or oentlino awartl for aootls.eauioment or service7 2) Pursuant to City Code Section 2I90, entitled"Prohibitetl Campaign ConMbWons By Lobbyists On Real Es[a[e Development Issues": _Yes_No: Are vou IoObvina on a d' aoolicatlon(or a De I t Aa eement with th CiN oliwUon fs cha ae ot zonina ma dea' fo or clunae to the C'N's F ture La tl Use Mao? 3) Pursuant [o Ciry Cotle Section Ya82(h�, any person (except thou exempt hom the defini6on of"IODDyisC as set forth in Section 2-481)who only appears as a representative of a not-for-profit corporation or entity vnthout special compensation or reimbursement for the appearance,whether direct or indireq to express support of or opposition to any item,s�all register wi[h the ciry clerk as required by this secGoq but shall not be required to pay any registration fees. _Ves_No: Are ou reoresentina a not-Tor-oroft corooration or entlN wHhout scecel mceruatlon or reimburaement? 4) Pursuant ro City CoGe SecUon 2-481, Me [erm "IobbyisP' specifiqlly exdudes the �dlovring persans: 6cpert witnesses who provide only scientific, technical or ot�er spedalized informa[ion or testimorry in public meetings; any person who only appears as a representative of a neighborhood assodation without compensation or reimbursement for the appearance,w0ether direct, intlirect or contirgent,to ezpress support of or opposNon to any item;and any person who only appears as a representative of not-for-profit communiry based organizafion for the puryose of requesting a grant without special compensation or reimbursemenl for Me appearance. _Ves_No: Are ro itlin onl acientltic techni al or ot�er c lalizetl Informatlon� a ead a a reRresentaHve of a neiahborhaod assoelation wlNoul soeclal comosnsatlon or re'mbursemeM or representinu a nobfor-oroflt basetl oraanlution for tlie oumoae of mauestlna a arant withoW �cial wmcensation or reimbursementl 5) Pursuant to Ciry CoUe Section 2<97�7), no campaign consultant shall lobby the Ciry Commission for a penod of 12 monihs following [he sweanng in of any elecled official(s)for whom the campaign wnsuttant pmvitle0 campaign cronsulting services within�he pas[election cycle. See Sedion 2-091 for more inkrmation. Ves No: H�ve vou movitletl camoalan consuttina servicen to an inwmbent member of the Ciri Commiss'on wlihin the oast election cvcle9 If vea.nleaae Iiat the Incumbant mem6eAa1 of the C'N Commise on� Ves No: I�es. has it been less than 77 months since the elected officiallcl whom vou orovltletl camoalan — — consultina servicw was sworn In7 6) Pursuant to CiTy Cotle Section 2162(a��4�a., a lobbyist who has within the past elec6on cyGe provi0ed campaign consulting services to an incumbent member of the Ciry Commission(which lobbyirg aQiviry is not ot�erwise prohibited by Code section 2-491) shall tlisclose such particular senice on his�her lobbyist registralion fortn an0 shall orellv disGosa such oa�ticular s rvice fo lobb in h Ci C mmission at a u�lic m 'n . Yes No: Have vou orovidetl wmoalan coneultlna services to an Incumbent member o/the CiN Comminsion within�he&pet eleCUon GVCk71f vea.okase Ibt the incumbent memhaAsl of�he Ciri Commlaalon' Vea No: It vea. were vou oromised or did vou receive economic consitlentlon In excharwe for camoainn consNtina services4 TO BE COMPLETED BV qTV CLERK'S STAFF ONLY Annuel Regbtntim he: N Yes[ ]No Amowt Pa1���r�rn.R R 4 �i� C7 Dafe Paltl lol „� LobEyiat RugiaVation Form received�nd venfletl by: L _ Revisetl 03/li)3020 Page 3 of 5 VI. SIGNATURES UNDER OATH: ON FEBRUARY 28 OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A SIGNED S7ATEMEN7 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 TATEMENT HALL FILE EVEN IF HERE HAS B EN N EXPENDITURE OR COMPENSATION I P RTING PERIOD.' SignaNreofLobbyist: Date � I do solemnty sweer or affirm that all of the foregoing facts, s[aMmen[s, and disclosures in this fortn are [rue and corred, and that I have read or am familiar with Me provisions contained in Chapter 2, Art. VII, Division 3, entRled "Lobbyists" of the Miami Beach Ciry Code and all repert A ments. Signature of Lobbyist: Date Signature of Principal: Date VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of State of Counry oh. Counry of. � � Swom to(or affirmed)antl su6scribed before me, Swom to(or affirtned)and subscribed before me, by means of O physical presence by means of O physical presence or O online notarization, or O online notarization, this_day of . 20_, by this_day of .20_, by NAME OF LOBBVIST NAME OP PRINCIPAL ProducedlD _ProducedlD FORM OF IOENTIFICATION FORM OF IDENTIFICATION _Pereona�o/wnq/^�}-��' _Personally Known j/,�'�fyyl/ /i(7C/T?� Signature of Notary ublic Signalure of No[ary P lic Name of Notary, Typed, Printed or Stamped Name ot Nofary,Typed, Printetl or Stampetl •�w"�,�w RohertaFernandez-Mbron NOTARV SEAL b�� �O-°� ( �,�`.�' .,,: Comm.:HH120235 (NOTARYSEAL) Commiesion FxDires: .uw���ay RoherM Famantlaz-Abran ���� � 127,2025 �:�r'���� Comm.:HH 720Y35 'The term"IoOb isY's edficall ezdudes ihe�followin persons: "�'��• ���R��P��' Y P Y 9 v;?'�� °nnnme• Apf1121.2025 Expert wMesses who prwide only sciendfic,technical or other speaalized informaUon or testimony in public meetings;any Oerson who only appears as a reDresentative of a neighborhootl assodalion vnNout compensation or reimbursement for the eppearence, whether direc[, indirect or contingen( to express wpport of a opposition ro any item; antl any person who only appears as a representa6ve of noFfor-profit community based organization for the purpose of requesting a grant wrthoN spedal compensation or reimbursement for the appea2nce. Page 4 oi 5 ,�n � ����IIBEAC ; � � Ciry of Miomi 6eovh, V00 Convennon Centar Drive, Mioml Beoch, Florida 33139,www.miami6eochN.gov Office of ihe Ciy Clerk Rafoel E. Gronodo, City Clerk CityClerk�miamibeachfl.gov Te1: 305.673 7411, Fax: 305.673 7254 NAME OF LOBBYIST: 1) LOBBYIST FEE EXPENDI7URE 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 shalt notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a tobbyist (or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, who fails to file the required Statement by April 30'^ 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 specfic issue on which I have been engaged to lobby. 2) LOBBY�ST 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 shail be $500.00 i� a to S tion 2�82 of the Miami Beach City Code. Signature of Lobbyist Date F 1LLERWLLkFORMSLLOBBYiST FORMSLLCOEyIp Regbtretion Fmm RMgM 0.in1-NqEG 4x Page 5 of 5 � . . 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