2024 Lobbyist Registration Form - Responsible Balloon Usage (Maria Stockham) -�es�9nSi�✓-l� ���p✓l Pits
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� Office o��he City Clerk
1700 Convention Center Drive
Miami eeach, FL 33139
305.673J411
LOBBYIST REGISTRATION FORM
Lobbyis� means all persons employed or retained, whe�her paid or no�, by a principal who seeks�o encourage the passage, tlefeat or
modificalion of any ordinance, resolutiory action or tlecision oi any commissioner, any ac�ion, tlecision, recommendation of ihe Ciry
Manager or any Ciry boartl or committee',or any aaion,decision or recommendation ot any City personnel tluring ihe time periotl of the
entire decision-making pmcess on such action, decision or recommendation ihat breseeabty will be heard or reviewed by the Ciry
Commission, or a Cily board ar commi��ee. The term specificalty includes �he principal as well as any employee engagetl in lobbying
activities. The term "LobEyisT has specific exclusions. Please refer to City Code Chapter 2, Article VII, Division 3, entitled "Lobbyisis,
for addi�ional information.
Insimctions: Please complete all sections o��his brm antl submit ihe completetl lorm,with Ihe applicable tee, �o�he Office of the Ciry
Clerk If you neetl more space�o complete an answer, use a separate sheel(s) of papec Ii you have nothing b report in a particular
sec[ion, you musl wnte "none° or "n/a" in that section. Any change to any information originally filed, or any addi�ional Ciry
Commissioner or pe�sonnel who are also sought�o be lobbied shall require�hat the lobbyis�file an amentlment to the registration brm.
The lobbyist has a con�inuing tlury to supply iniormation antl amend the forms filed �hmughout the period Ihat ihe lobbying occurs.
Separate registration torms shall be required for each principal represented on each specific issue.
I. LOBBVIST INFORMATION:`^ ' I
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NFMEOFLOBBVIST (tast) (Frs�) (MitlaleName)
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LOBBVISTBUSMESSNNMEANDA�DRESS (NumbarantlStreet) (G�y) (S�ate) (ZipCotle��6'}S�
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II. PRINCIPAL INFORMATION: � tt�
Stockham Maria
NAMEOFPRINCIPAL (Last) IFrst) (MltltlleName)
Coalition For Responsible Celebra[ion 100 Tice 81vd Woodcliff Lake N� Q�6�
PfiINCIPALBl15ME5SNAMEANOADDRE55 (NumberantlShee�) (Ciry) (State) (LpC e)
siz-asa-�aso �rn� us a���t
PRINCIPALBUSWESSTELEPHONENUMBER CELWLARTELEPHONENUM6ER EMAILADDRESS
Pursuen�ro Clry Code Seclion 2J82(h)(1)�a): A pdncipal ol any corporatlon, patlnarshlp, or other enllry who appears as a lobbyls�on behal�ot Nat
entity,withoW special com0ensa�ion or reimbursemen�br�M1e appearance,whe�her direc�, intlirect or con�ingenl,ro express suppotl oi or opposition lo
an item shall regis�er wifi tM1e Clerk as requiretl by IM1is su�seqion but sM1all not be requiretl m pay any regisvation lees.
If ihe principal is a Corporation, Partnership or Trust, the following information MUST be provided
pursuant ro City Code Section 2-482(c):
. NAME OF CHIEF OFFICER,PARTNER,OR BENEFIqARV(if none,write NIA): Ma�ia Stockham
. NAME OF ALL PERSONS HOLDING,DIRECTLV OR INOIHECTLV,A 5%OR MORE OWNEHSHIP INTEHEST IN SUCH
CORPORATION,PARTNEPSHIP OH TRUST(if none,write NIA):�.. -
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III. ISSUE TO BE LOBBIED:
Describe with as much detail as is practical, including but not limited ta a specific descriptian where
applicable of a pending request for proposal, invitation to bid, or public hearing number.
To work together with the city council and local businesses to fnd a solution that strengthens the local community
and promotes responsible balloon usage.
AN ORDINANCE OF THE MAYOR AND CITY COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA
AMENDING CHAPTER 82 OF THE CODE OF THE CITY OF MIAMI BEACH, FLORIDA,
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 ot the subject contractual relationship.
Full Name of Individual and Contractual Relationship(If yes, explain) vES NO
Title of Person to be Lobbied
v � Eav�t��nn`ss� oHeu s N�
Pursuant to City Code Section 2-482(g), every registrant shall be required to state the extent of any
business, financial, familial or protessional 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 ihe lobbyist registration torm filed.
List any Business, Financial, Familial or Protessional Relationship, or other relationship giving rise to an
a earance of im ro riet ii none,write N/A :
N/A
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION - Be Soecific. (Note that a
coniingency fee is prohibited pursuant to City Code Sec. 2-485.3):
-�
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The following siz(6)questions MUST be answeretl:
1� Pursuant to Ciry Code Section 2-488,entitletl'Prohibi�ed Campaign ConViCulions By Lobbyists On Procurement Issues`.
Ves xNo: Are vou lobbv'no on a present or oentlina bitl for aootls eouioment or services. or on a oresent or
pendina awartl for nootls enuioment or service7
2) Pursuant to Ciry Code Section 2-490, entitled "Prohibitetl Campaign Contributions By Lobbyists On Real Estate Development
Issues"
Yes x No: Are vou lobbv'na on a oentl'na aool'cat on for a Develooment Aareement with ihe Cin or aoolication
for chanae of zon'na mao tles'onat on or chanae to the Citv'S Future Lantl Use Mao?
3) Pursuant to Ciry Code Section 2-482(h). any person (except Ihose exempt from the defini�ion af "lobbyist" as set forth in
Section 2-481) who only appears as a represenlative of a no4for-pmii�corporation or entity without special compensation or
reimbursemem for�he appearance,whether tlirect or intlirea m express supporl of or opposition ro any item,shall register with
tha ciry clerk as requlred by ihls section,but shall not be requlretl to pay any regisVation tees.
x Ves No: Are vou reoresenYno a nat�for-orotit corooration or entitv without soecial comoensation or
reimbursement?
4) Pursuan� �o Ciry Cotle Section 2-481, �he �erm "IobbyisP specificalty exclutles ihe following persons Expert witnesses who
provitle only scien�ific,�echnical or other specializetl iniormation or testimony in public meelings;any person who only appears
as a representative of a neighborhootl associa�ion wi�hou�compensation or reimbursement�or�he appearance,whether tlirect,
indirec�or contingent,to express support o�or opposition to any item',antl any person who onty appears as a represema�ive of
no4for-profit community basetl organiza�ion for ihe purpose ot reques�ing a gran� without special compensation or
reimbursement for Ihe appearance.
Ves KNo: A o o �d a IV tf' t h ' I o o�he 9De ' I' tl ' f � p ear'na e
ep ese tat i �ahb a d a35oC et On without so � I o T n or re'mbursement or
p C bf - ft ba tl o ' t f th se of reo f o t 'th t
soecial comoensation ar reimbursement?
5) Pursuant to Ciry Code Sec�ion 2-491(1), no campaign consultant shall lobby the Ciry Commission for a period of 12 months
following �he swearing in of any elected official(s) for whom �he campaign consWtant provided campaign consWting services
within the past elec�ion cycle. See Seclion 2�491 for more iniormation.
Ves XNo: Ha V o 'd d tamoa'a Co Sult a t an 'nc mbent member of the Citv Comm'ssion
'ih' ih o t I cT n c Ne� If v ol I' t ih ' mbent memberfs)af ihe C'iv Comm"ss'on�
F/ly1 _Ves_No: If v h s 't been less than 12 monihs s'nce t�e electetl off'c'al(sl whom vou orovitletl camoaian
� cansultina services was sworn in?
6) Pursuan��o City Code Sec�ion 2�A82(a)(4)a., a lobbyist who has within �he past election cyde pmvided campaign consNting
services ro an incumbent member of�he Ciry Commission (which lobbying activity is not otherwise pmhibited by Code section
2491) shall tlisclose such patlicular service on his/her lobbyist registration form and shall orallv d'sclose such oatlicular
service before IobbJna the CN Comm ssion a�a oublic mee�ino.
y¢s x No: H �tletl o 'a I[' sery ies to an 'ncumbent member of the Citv Camm'ss on
'th' th o t elecfo cvcl �If v ol I'st Ihe'ncumbent member(sI ot Ihe Ctv Camm'ssion:
N I� _Yes_No: If es v o ed or tl tl vou rece've econom'c cons'tlerat on 'n exchanae for camoainn
consultino services?
TO BE COMPLETED BY CITY CLERK'S STlAF'F ONL(Y�
AnnualRegisValionire: � ]Ves�QNo AmouniPa�itl$�z/Q;�r'o MCHN 1� �1 DateVaitl � � "�
LobOyis�Hegistration Form receivetl antl verilietl by: /< (_1Gl!'b0 t�
- •�rrir � n�.��. n-ys<ae �nFormaw�.seem-u-mnecAw ReviseE03/11/2010
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VI. SIGNATURES UNDER OATH:
ON FEBRUARV 28 OF EACH VEAR. EACH LOBBVIST SHALL SUBMIT 70 7HE OFFICE OF THE CITY CLERK A
SIGNED STATEMENT UNDEH OATH LISTING LOBBYING E%PENDITURES. AS WELL AS COMPENSATION
RECEIVED FOR THE PRE EDING CAL NDAR VEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENG GE T . A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
E%PENDITURE OR COM ATI D THE REPORTING PERIOD.'
Slgnature of LobbyisL ' _ _ Date �� � 2
I do solemnly swear or a�firm [hat all of �he foregoing facis, statemenis, and disdosures in this form are irue and correct,
antl that I have read or am fami iar w th the pmvisions containetl in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
the Miami Beach Ciry Code nd II re � ing requirements. I ���/��
Signature oi Lobbyist _ Da�e ,. ..
Signature of PrincipaC ����� Da�e � � � _ �'� __.
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VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
stateof �CYIC�C� stateof �f!`��(��L1 )
CounryoC A �If1Y1')I— fJ�L�t Counryof: Y1,�1(�VI'11—�.lGli
Swom ro(or affirmed) and subscribed before me, Swom to (or affirmed) and subscribetl before me,
by means of f� physical presence by means of Cxphysical presence
or 0 online notarizaYon, or o online notarization,
this l�l day of�Il��� .C1Y�2014by this�tlay of �l'i1'lUQY4 . 20 t4by
A,1[�r�n 1�i�rnl�l��ir �c "�i,���ruv� �,Inr,n lae�ri� A.I�,,��cic �h,cl�M����
NAME OF LOBBVIST NAME OF PRINCIPAL
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Y Produced ID 1.�Y IVt�(`� � N � �Produced ID JI�1 ViY �S Li �r I 1SC
FORMOFI�ENTIFlCATI N FORMOFIDENTIFlCATION
Personally Known Personally Known
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Signature of Notary Public SignaNre ot Notary ublic �
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Name of otary, Typed, Prin[ed or Stamped Name of Notary, yped, Printed or Stamped
,���:. "-.. ..
V EAL
:F^ �n': SAYUGUTIERRFZ :':?:"'�'�`k;'�,
: . SAYU GUTIEHREZ
'� `E MY�CpOmAI�Mc�� MYCOMMISSIONpHHd53348
� .��j�'(obbyis� spec�4�IP{L}idQ�es efollowingpersans' �'.?e�;;o":�' EXPIRES:OdoOerfl,2027
Expert witnesses who provide onty scien�ific,technical or other specialized informa�ion or testimony in pu i ings;any person who
only appears as a represema�ive of a neighborhootl association wi�hoW compensation or reimbursement br Ihe appearance, whether
direct, intlirect or contingen�, �o express support of or opposition to any item�,and any person who only appears as a representative of
nobfor-pmiit community based organization tor the purpose oi requesting a grent wi�hout special compensation or reimbursement for
ihe appearance.
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� � innn � gEACH
Ciry o(Miami Beach, 1700 Convenrion Cenrer Dme,Mloml Beoch, Flonda 3313Q www.mlomibeachll.qo�
Office of rhe Clry Clerk
Rafael E Gmnadq City Clerk CiryGlerk�miomibeachfl.gov
Tel: 305.673741 I, Fax: 305.6737254
NAME OF LOBBYIST: �°wrt�� � S IaCKik� ' �l
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 tines 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 specific issue on which I have
been engaged ro 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
comme cin Octo er 1 of each year, and the fee for such annual registration shall be
$500.0 ur ua t Section 2-482 of the Miami Beach City Code.
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Signature of Lobbyist Date
F\CLEP\SFLVaFOFMSLOBBVI$i FOPM54o��yv�PegnuaLon Form Pensetl 03-t 620 REG tloc
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