2024 Lobbyist Registration Form - 415 Arthur Godfrey RD (Norman Blandon) ► RECEIVED
� � � n � � ! R � �� � �'�� lAN 022024
Offce of the City Clerk
1700 Convention Center Drive
Mlami Beach, F�33139 G!TY 01= �^.�iiAMl BEACH
305.6737471 '� .'. ' ..'_�',K
IOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, tlefeat or
modifcation of any ordinance, resolution, action or decision of any wmmissioner, any action, decisioq recommendation of [he Cily
Manaqer or any Ciry board or commit[ee:or any action,decision or recommendation of any City personnel during the time period o(the
entire tlecision-making pmcess on such action, decision or recommendation [hat foreseeabry will be heard or reviewetl 6y the City
Commission, or a City boartl or commiflee. The term specifically includes ihe principal as well as any employee engaged in lobbying
activitiea The tertn "Lobbyist" has specifc exqusions. Please refer to Ciry Code Chapter 2, ArtiGe VII. Division 3, entiUed "Lobhyists,"
for adtlilional informa[ion.
Instmctions: Please complele all sections of Ihis form and submil ihe completed form, with Ihe apP�icable fee, to the Offce of the Ciry
Cle�k. If you need more space to complete an answeG use a separate sheel(5) of paper. If you have nothing to repotl in a particulai
section, you must wrile "none" or "n/a" in Iha� sec�ion. Any change to any informalion originally fletl, or any atltlitional City
Commissioner or personnel who are also sought to be lobbied shail require that the lobbyist file an amendment to Ihe registralion form.
The lobbyist has a continuing tlury to supply intorma�ion antl amantl the forms filed ihroughout ihe period Ihat t�e lobbying occurs.
Separate regislralion forms shall be required for each principal representea on each specifc issue.
I. LOBBYIST INFORMATIONn:
NAME OF LOBBYIST ����st)D�° ��rst) � (Mitltlle Name)
�31ss
�l 2S,�2CbV'I�c.Y�-I.FZeF C°o. Cv 2 G Z �lRA G?.�R41� . 2Cy A/dLA l���
LOBBVISTBUSWESSNAMEANDADDRESS (NumOerandStreel) (City) (State) (ZipCotle7
2,d5 �(� � 51 s l 3as 2q� 2�12 J�/ /�/'j�f.GG
LOBBYISTBUSINESSTELEPHONENUMBER CELLULARTELEPHONENUMBER EMAILADDRESS
II. PRINCIPAL INFORMATION: � /
P��61�J,DoIJ� I'uDlz,n�l/.d�✓
NAME OF PRINCIPAL (Las[) (First) (Mldtlle Name)
331s�—
1V 2 � A/�ra`��'�Y7�r2d Co_ C� ZG Z 7�11�v �a� - 2U �i�Mi. FZ.
PRINCIPALBUSWESSNAMEANDADDRESS (NumberantlStreep (City) (S�ate) (ZipCoe)
�s' ��� s� s/ 3as' 2a -i 28r2- eNzs� �
PRINCIPAL Bt1SINE5S TELEPHONE NUMBER CELW LAR TELEPHONE NUMBER EMAIL ADDRE55
Pursuanl b Ciry Cotle Sedion 2>82(h)(1)(a): A principal of any corpo�ation, pahnersM1lp, o� o�he�en�lty wM10 appears as a lobbyist on be�alf o}@a[
enlily,wi�hout speciai compensation or reimbursement for the appearance,whether tlirect inairecl. or contingent to express suppon of or opposition to
an i�em shall regis[er with�he Cleik as requiretl by�Itis subsection but shall no�be�eQuiretl to pay any regisiretlon fees.
If the principal is a Co�poration, Partnership or Trust, the following information MUST be provided
pursuant to City Code Section 2-482(c):
• NAME OF CHIEF OFFICER,PARTNER, OR BENEFICNRY(if none,write N/A): NOffl'1Bf1 Bldfld0fl
• NAME OP A�L PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST(if none,write N/A): N�A
Page 1 of 5
� ��
III. ISSUE TO BE LOBBIED:
Describe with as much detail as is prectical, including but not limited to a specific description where
applicable of a pending request for proposal, invitation [o bid, or public hearing number.
rP����y� . Q� �2� 415 Arthur Godfrey Road
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 Ci[y to the present date, stating the general nature of the subject contractual relationship.
Full Name of Intlivitlual antl Contrectuai Relationship (If yes,expiain) YES NO
Title of Pereon to be Lobbietl
L I. O
Pursuant to City Code Section 2-082�g�, every registrent 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, Famflial or Pmfessional Relationship, or other relationship giving rise to an
a earance of im ro riet if none,write N/A :
N/A
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION - Be Specific. (Note that a
contingency fee 's prohibited pursuant to City Code Sec. 2-085.3):
� �i S�, sa G�E�L h-{cJU F�
4�V�
Page 2 of 5
The following six(6)questions MUST be answered:
1) Pursuant to City Cotle Section 2488,eNitletl"Prohibited Campaign Contributions By Lobbyists On Pmcurement Issues':
_Yes V No: Are o 1 bb ' a o t o oentl'no b'd f tls eau'o e t or serv'ces r a a t
aendina award for qootls equioment or service7
2) Pursuant to Ciry Code Seclion 2�490, entitled "Pmhibited Campaign Coninbutions By Loh6yists On Real Estate Development
Issues':�
_Yes�/No: Are vou lobbvinq on a centlln5l appllcation for a Devaloomen/Aareement with the CIN or aOPI'cat'on
for channe of zonino mao tlesianation or channe to the Citv's Future Wnd Use Mao�
3) Pursuant to City Code Seclion 2-082(h), any person (except those ezempt from ihe definilion of "lobbyisf' as set forth in
Section &48�) who onty appears as a representative of a not-for-profit corporetion or entity without special compensation or
reimbursement for the appearance,whether tlirec�or indirect to express support of or opposition to any item,shall register wilh
the city dark as required 6y this section, but shall not be required to pay any regisiration feas.
_Yas�No: Are v u t' q t-0 -p flt atl Etv 'th t o I I m [' r
r¢imbursement?
4) Pursuant to City Code Section 2d81, ihe term "IobbyiSP' specifically excludes Ihe following persons Expert witnesses w�o
pmvide only scientifiq technical or other specializetl information or testimony in public meetings;any person who only appears
as a representa[ive of a neighborhood association withoul compensation or reimbursement for the appearance,whether tlirecl,
indirect or contingent,to express support of or apposition to any item; and any person who only appeare as a representative of
not-for-prof� communiry based organization for the purpose of requesting a grant wi�hout special compensation or
reimburseJ"ent tor the appearance.
_Yes V1Jo: Are vou orovitlina onlv cientific technical or other oecialized information' aooearina as a
reoresentative of a neiahborhootl association without suec'al comoensafon or re'mbursement ar
�se C a a o4fo -n ft b d o a ' af f th o e of ea esE t 'th t
special comoensation or reimbureement?
5) Pursuant to Ciry Code Section 2-097�7), no campaign consWtant shall lobby the City Commission for a penad of 12 mon�hs
following the sweanng in of any elected oKcial(s)tor whom the campaign consultant provitletl campaign consulting services
within thepast elaction cycle. See Section 2-491 for more information.
/
_Yes� No: Have vou orovided camoaiqn cansult'no serv'ees to an 'ncumbent member of the Citv C
within the oast election cvcle? If ves.nlease list the ineumbsnt memberlsl of the C'N Comm'ss'on'
_Ves_No: If yes has 't been less than 72 months s'nce the i cl d k' ' I( 1 h o o 'd d 'q
consultinq services was sworn in�
6) Pursuant to City Cotle Section 2-082�a��4)a., a lobbyist who has within lhe past election cycle provided campaign consWting
services to an incumben[member of Ihe Ciry Commission (which lobbyin9 activity is not otherwise prohibited by Code section
2-497) shall tlisclose such particular service on his/her bbbyist regislration form and shail orallv disclose such oarlicular
service be re lobb in the Ci Commission at a ublic me tin .
_Ves_No: Have vou orovided camoa'an consult'na serv'ces[o an "ncumbent member of the G'N C
within the oast eleefon wcle�If ves oleau fst[he'ncumbent mam6er(sl of th C'N C 'o '
_Yes_No: I�es were you promisetl or d'd vou receive e 'tl aC n in ex h f ua'g
consultina services?
TO BE COMPLETED BV CRY CLERK'3 STAFF ONLV
Annual Registrallon fee: [ ]Ves( ]No Amoun[Paid$ MCR# Oarc Paid
Lobbyist R¢gistralion Foim receivetl and verifietl by:
_._ . - _ - ReviuCO3J11/2020
Page 3 of 5
VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH VEAR EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITV CLERK A
SIGNED STATEMENT UNDER OATH LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSA710N
RECEIVED FOR 7HE PRECEDI CALEN R YEAR H REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAG D TO LOB Y. A ST ENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPE TION TH RTING PERIOD.'
Signature of LobbyisC Date��3
I do solemnly swear or aHirm th �all of th fore o g facts, statements, and disclosures in ihis form are true and correct,
and that I have read or am fa iar with t� ovi ons contained in Chapter 2, Art. VII, Division 3, entitled "Lob6yists" of
the Miami Beach City Cod all repo�' r re ents.
Signa[ure of Lobbyist: Date �Z�y('L°i
� �
SignaNre of Principal: Date ���
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
S[a[eof ��� �� Sfateof �LU� ��
Counry of: 1�'e'�Q"�``-� �"A�-t Counry ot �--�.c 'QR-Z-e �a YJ'�
Swom to(or aff�r' etl) and subscribed before me, Swom to (or aff�ir d)and subscribed before me,
by means of 8'physical presence by means of Tlphysical presence
or � onli notariza[i I � or� ogLpe no[ar tion,
this�ayof ��/ . 20� by Ihis��{Ll4�ayof ��-F ^^�� 20�-'?by
���2NGA1� l�'L.�A�UI'JD,U r�TGM�AN �'�-/JDa�
�L'OF LOBBVIST NAMEO PRINCIPAL
ProducedlD ProducedlD
/ FORM OF IDENTIFlCATION � FORM OF IDENTIFlGATION
/
r�Personally Known `�/0 —Personally Know
Signature of Notary Public Signature of Notary ublic
z��(r �a-tt�-F,4 c � 2��-(o hl��� c �
Name of Notary, Ty ted or yNIp�6Rdelo Name of Notary, Typed, Printed or Stamped
Comm.:p HM 320135 �.. �y�
(NOTARYSEAL) � �q;rypv9mber2,21126 (NOTARYSEAL) J' �4 �m.�����
•e'a^� Notery Pubfic-$tab M FlaiCa � �:Noran�ber 2.Y028
�••••� Nolay Pu01ic-SIaY of Fkrida
� The term"IobbyisC'specificalty exdudes the following persons:
Expert witnesses who provide only scientific, technical or other specializetl 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
tlirect. indirecl or contingent. to express support of or opposition lo any item; and any person who onty appears as a representative of
not-for-proft communiry based organization for ihe purpose of requesting a grant wilhout special compensation or reimbursemenc for
the appearance.
Page 4 of 5
r
__
. l..` �'. _ ?'_'\\._ I-7
Cify oi Miami Bwch, V00 Convention Cenrer Drive,Mlami Beoch, Florido 33139,wwacmlamibeachfl.gov
ONice of ihe City Clerk
Rafael E Gmnado, Ciry Clerk CityClerk@miami6eochfl.gov
Tel: 305.673.741 7, Fax: 305.673.7254
—�
NAMEOFLOBBYIST: IyOJLJLj/�� ��/�F�ON
7) 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 notifcation.
Any lobbyist, who fails to file the required Statement by April 30i^ 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 Clerlc.
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 pursu� to Section 2-482 of the Miami Beach City Code.
�
��
u � 2
Sig ture o obbyist Dat
r.;ciemsa�wroxms�yoeevis�vownsuaeey�wa¢y��rnp�ra�.�.ree.�e orii.xoaEcu«
Page 5 of 5