2024 Lobbyist Registration Form - 761 Jefferson Ave (Jamie Mandel) ��G,� Se�ec�n ✓-lve-_
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1700 Conventlon Center Drive SEP
Miami Beach, FL 33139
305.67374N CIT';' OP MIAMI BEACH
LOBBYISTREGISTRATIONFORM G";�'.C�OFTHEGI�CLFnK
Lobbyist means all persons employed or retained, whether paid or no�, by a principal who seeks lo encourage lhe passage, defeat or
modifcation of any ordinance, resolution, action or decision of any commissioner', any action, decision, recommentlation of �he City
Manager or any City board or commitlee; or any aclion, tlecision or recommendation of any Ciry personnel during ihe time period of�he
enlire decisiommaking process on such action, decision or rewmmendation �hat foreseeably will be heard or reviewed by the City
Commission, or a City board or committee. The term specifcally inGudes the pnnciDal as well as any employee engaged in lobbying
activities. The term "Lohbyist" has speciFlc exclusions. Please refer ta City Cotle Chap�er 2, Ahicle VII, Division 3, entiiled "Lobbyists,
for adtlilional information.
Instmctions: Please complete all sections of ihis form and submit the completed form,with the applicable fee, to ihe OHce of ihe City
Clerk. If you neetl more space to complete an answer, use a separate sheet(s) of paper. If you have no�hing to report in a particular
section, you must wri�e "none" or "n/a" in �ha� section. Any change to any information originally fled, or any additional CiTy
Commissioner or personnel who are also sou9M to be lobbied shall require�hat the lobbyist fle an amendmeN�o�he regisiration form.
The lobbyist has a wnlinuing dury �o supply information and amend Ihe forms fled throughout ihe period lhat ihe lobbying occurs.
Separele registration forms shall 6e required for each principal represented on each specifc issue.
I. LOBBYISTINFORM�if�: �- / ��V�'
�G� CpiYO
NAME OF LOBBVIST (Las[) (Firsl) (Mitldle Name)
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LOBBVIST B INESS NAME AND ADORE55 (Number antl Street) (Qty) (S�ale) (Zip Code)
LOBBYISTBUSWESSTELEPHONENUMBER GE�ULARTE�HON���ER ��rG�EIIILAOOREI S�aW �
II. PRINCIPAL INFORMATION:
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NAMP F PRINCIPAL (Lest) (Flrst) (Mltltlle Neme7
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PRWCIPAL BUSINE55 NAME AND A�ORESS (Number antl Slreet) (Ciry) (State) (Zip Cotle�
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PRINCIPALBUSWESSTELEPHONENUMBER CELLULARTELEPHONENIIMBER EMAILADDRESS
Pursuanl lo Cdy Code Section 2-082(�)(1)(a)'. A principal ot any corporetion, paMership, or other entity who appears as a lobbyist on behalf of t�at
entity,withoul special compensation or reimbursement for Ihe appearance,whether tlirxt, intlireci,or contingen�,to express support of or opPosition to
an item shall register wdh ihe Clerk as requiretl by ihis subsec[ion but s�all nol be requiretl to pay any regisUation fees.
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided
pursuant to City Code Section 2-482(c�: ^�'' /��;_ J� /
• NAME OF CHIEF OFFICER, PARTNER,OR BENEFICIARY(if none,write N/A�: J �V�� / � «'��/l.
• NAME OF ALL PERSONS HOLDING, DIRECTLV OR INDIRECTLV,A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST(if none,write N/A�:
Page 1 of 5 �
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III. ISSUE TO BE LOBBIED:
Describe with as much detail as is practical, including but not limited to a specific description where
applicable of a pending request for proposal, invitation to bid, or pub�l�ic hearing number.
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IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482�a�(4�, list the Ciry 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 Contractual Relationship (If yes,explain) YES NO
Title of Person to be Lobbied
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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
a earance of im ro rie if none write N/A :
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):
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Page 2 of 5
The following six(6)questions MUST be answered:
i) Pursuant to City Code Section 2-088, entitled'Prohibitetl Campaign Contributions By Lobbyisis On Procurement Issues":
Ves�o: Are vo I bbv' a o t p d' a b'tl f ds ea �o t r serv'ces or on a oresent or
p d' q a tl fo 4 d a �D e t 'te�
2) Pursuant lo City Code Section 2-090, entitletl "Pmhibited Campaign Contribulions By Lobbyists On Real Estale Development
Issues'�
Yes No: ou I 66v' n on a ce d o ool'catio f D loo e t An ment 'th th C'tv o aool' t n
for cha a f 'na mao d 'n t'on or cha a t the CiN's F t Lantl Us M o�
3) Pursuant to Ciry Code Section 2-082�h�, any person (except those ezempt from Ihe defnition of "IobbyisY' as sel fotlh in
Section 2-481) who only appears as a representative of a nobfor-proft corpora�ion or en�ity wi�hout special compensation or
reimbursement for the appearance,whether direcl or indirec[to express suppotl of or opposition to any item, shall register with
ihe city clftk as required by ihis section, bul shall no�be requiretl to pay any regisiration fees.
Ves��No: Are vou ❑ t na a t f -o f't co o t' e Ctv 'th t soec' I a sat on or
reimbursement?
4) Pursuant to Cily Code Sec�ion 2d81, Ihe �erm "Io6byisT' speci0wlly excludes �he following persons'. Expert wi�nesses who
provide only scientiflc, lechnical or olher specialized information or teslimony in public meetings�, any person who only appears
as a representative of a neighborhood association wi�hout compensation or reimbursemen�for the appearance,whether direcl,
indirect or contingent,to ezpress suppotl of or opposition to any item; and any person who only appears as a representa�ive of
nobfor-proft communiry based organiza�ion for lhe purpose of requesling a granl wilhou� special wmpensa�ion or
reimburs entfortheappearance.
Ves No: A vo o 'd' u I sc' t'f' te hn'cal th oec'al" d ' f mato � oo ' a a
represe t t' f a e'ahb a d assoc'at' 'tho t so ' I oensat' �mb rsement or
a se f a t f o of't b d a ' f f the ou o f ea f 4 a ant without
soec'al comoensation or reimbursement?
5) Pursuan� lo City Code Sec�ion 2d91(1), no campaign consultant shall lobby the Ci�y Commission for a period of 12 monlhs
following the swearing in of any elected oHicial(s) for whom the campaign consWtant pmvided rampaign consulting services
within the/�a st election cycle. See Section 2-491 for more information.
Ves V No: H oro 'tl d 'an co Iti erv'ce t ' c mbent member of the C'N Commission
'th' the oast el C cle>If v olease I'st the'ncumbent memberlsl of the CiN Commission:
Ves No: � v^� has 't be I s tha 12 ths s' th elected off c allsl whom vou oravided camoaiqn
consultinq servi ces was sworn in?
6) Pursuanl to City Code Section 2dffi�a)�4)a., a lobbyist who has wi�hin ihe past eleclion cycle provided campaign consulting
services to an incumbent member of ihe Ciry Commission (which lobbying ac[ivity is no�otherwise prohibiletl by Code section
2-491) shall disclose such patlicular service on his/her lobbyist regisUation form a d shall oralN d'sclose such oahcular
service b re lobb in �he Ci Commission at a ublic meetin .
Ye No: H e vou o 'ded camoa'a nsult' a 'ces to mbent member of the C'N Commission
'thin the o t elecCo v I '+If ves ol fst th ' bent memberlsl of the CN Commission:
Yes No: If ves o o ' d or dtl v ece' m'c cons'derat'on 'n exchanoe for camoaian
consultina senices7
TO BE COMPLETED BY CITY CIERK'/S/STAFF ONLY7 1
Annual Registration fee: [Jj Ves� ]No Amount Paitl E�--�'�" >� MCR#T�/ �� / J� Dafe Pa1C � �
Lobbyist Registntion Fonn receivetl antl varifetl by �7��
F:\CLE0.\SA���dFORMS\LOBBYISTFORMS\lAbEyirtRegiRvdtionFo�mReviStd P3-11-lOkEG.dac R2VI5¢d�3/11/2020
Page 3 of 5
VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR. EACH LO8BYI5T SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNED STATEMENT UNDER OATH LISTING LOBBYING EXPENDITURE5 AS WELL AS COMPENSATION
RECEIVED FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPENSAT ON DU I THE REPORTING PERIOD.' //
Signature of Lobbyist: " -� Date ��/^7
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 r o � re irements. �/�����
Signature of Lob6yist: � Date
Signawre of PrincipaP. ,�� � Date ���Z�'�-4"�
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL/
State of ��rl �a State of I (Url�L9�--
County of: /�/u�l�l JJ� County of: �//Q/✓vl �
Swom to (or affi�ed) and subscrihed before me, Swom to (or affyr �ed) and subscribed before me,
by means of Efphysical presence by means of C3'physical presence
or� online notarizatioa or 0 online notarization,
this�day of .7��'+'�hD� , 202�by this�day of SeOfC M�� . 202X 6y
�eeGra /rl. ✓i//a �a�2 /h�w�
NAME OF LOBBVIST NAME OF PRINCIPAL
ProducedlD _Produced
/� FOR F IDENTIFICATION /' FOR F ID IFlCATION
V Personall K o n I 1 =Person Ity no n
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i ti,
Si nature o Nota ublic Signat�e of Nota Public
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; MohryYu�lic�StaMOIFIorIE� .'. MotrymDlic�Stebo�FlonO�
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-�,.w n i qy;wnm.Evplrez ieE B,t02! "'•°���^' MY�^^�m.Expires ieb 7,202!
� 3antee thmug�Nation�l uotary bm. 1onCM t�rouyh Netional Naary Um,
'The term"Iob6yisP'specifcally excludes the following persons:
Expert witnesses who provide only scientifc,technical or other specialized information or testimony in public meelings; any person who
only appears as a representative of a neighborhood association withou� compensalion or reimbursement for lhe appearance, whelher
direc[, intlirect or wntingent, to express support of or opposition to any item', and any person who only appears as a representative of
no4for-pmfi� community based organization for�he purpose of requesling a grant without special compensa�ion or reimbursement for
the appearence.
Page 4 of 5
Cily ol Miami Bwah, V00 Convemion Cenler Dnve,Mlami Beach, Fbnda 33139,www.mlomlbeachA.gov
OHi<e of the Ciy Clerk
Rafael E. Gmnado, City Clerk CilyClerk@miamibeachA.gov
Tel: 305.6737411, Fa.: 305.6737254
NAME OF LOBBYIST: ���a ��/� V/��Gl
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 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 specifc 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 Offce 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.
�.�:� 3 �
Signature of Lobbyist Date
F\CLERWPLL�eFORMSYLOBBYIST FORMBLLOE�yis�Regv�reLon Fo�m Revige� 09�fi-40 PEG Doc
Page 5 of 5
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�E>JEIVED
City of Miami Beach
1700 Convention Center Drive SEP 05 2024
Miami Beach, Florida 33139
www.miamibeachfl.gov CITY OF MIAM! BEACH
City Clerk's Office oFFir,e;•���T� ��•-. ���,rvC�eaK
Tel: 305-673-7411
Fax: 305-673-7254 Office Use Only
ANNUAL LOBBYIST REGISTRATION FORM
Name: ��ro / ' /- l/ 1 II�
Business Name: �/ � //G � V I / 1� `�^^'"
Address: .Y--LJ ��S� r'`'�f �- �I voI . /yG�� . {L 3 3�3 �
,
O�ce Telephone Number:
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Cellular Telephone Number: � J ' O " 3 — ��oC=�
Email Address: 1��17 . V I ��G @ �1�1)(0.�L111>. US _
If more than one/obbyist, p/ease list:
1)
2)
3)
4)
5)
6)
7)
Submit this form to the Office of the City Clerk, along with a check for $500 for each
lobbyist. Please make the check(s) payable to the City of Miami Beach.
For City Clerk's Office Use Only
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