2024 Lobbyist Registration Form - CAC Grant (Anna B. Klimala) � 1�1 G � �a.�}
RECENED
, P, �� I ra A �i � [����� �,ceormec�rycier� AUG 202024
� �' 1 l..,i
1700 Convention Center Drive
. Miami BeacR FL 33139 CITY OF AAIAMI BEACH
305fi737411 OFFlCE�"� `H�.=CITY CLFRK
LOBBYIST REGISTRATION FORM
Lobbyist means all persons em0loyeG or retainetl, wheMer paitl or not, by a pnncipal who seeks to encou2ge�he passage, tlefeat a
matlifiwtion of any ortlinance, resolution, action or tlecision of any commissioner; any adioq Cecisiory recommentlalion of Me City
Manager or any Ciry ooartl or committee:or any action,tlecision or recommentlation of any Ctty personnel tluring ihe time periotl otMe
entire tleusion-making process on suc� ac0on, tlecision or recommentlation Ihal foreseeably will be heartl or reviewetl by the Ciry
Commission, or a Cdy Eoard or committee. The term specifically intludas the principal as well as any employee engagetl in lobbying
activities. the tertn'Lobbyist'has specific exGusions. Please refer lo Ciry Cotle Chapter 2, Article VII, Division 3, enfitle0'Lobbyists,'
br atl4iHonal iniortnation.
InstrucLons: Piease complete all sections of Ihis fortn antl submit Me completetl fortn,with ihe appliwble fee,lo t�e Office of the Giry
Clerk. If you neetl more space to wmplete an answer, use a separate sheet(s) of paper. If you have nothing to report in a particular
sec�ioq you must wnte "none' or `nla' in that seclian. Any change to any informalion onginalty fileQ or any atltlitional Ciry
Commissioner or personnel who are also sought to Ee lob�iea shall reQuire ihat ihe lobbyist file an amentlment to ihe regisiration form.
T�e IobEyist has a wntinuing tluty lo supply information antl amentl the fortns filetl ihmughout ihe penoC lhat the IobGying occurs.
Separete registration fortns s�alt be repuired for each pnncipal represented on each specific issue.
I. LOBBYIST INFORMATION:
�r�n a l�e,- `fau I r�v
NFMEOFLOBBYIST ILazt) (Firsp (M' Name�
N\�auv�� Mus�c �ru� �J t 1� �,�J g� � `�e� �a N1�,wi� k L �313 �P
LOBBYI516USWESSWIMEANOA� 55 (Num�eraed5ireep (CM) (Slate) (ZipCaEe)
�S (� •uaa-sa-� i �� a � 3 �i . 3gs3 l�e��rn�; w�s�cp+��.
LOBOYIST BOSMESS TEIEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAiL ADDRESS .A'L�
J
II. PRINCIPAL INFORMATION:
K��/YIAIG �/1/,L �Il Cc�e�'�
NAMEOFPRINCIPAL (Lasp (Firsp (MqtlleName)
'N�iftiuh � �V1uSt�pr��P.C�' lol NV� ��'-�{- �20o WI�Yvu,i,� �3/3 �P
PRI CIPAL BUSINE55 NAME AN DDRE55 (Num�er aM Sireet) (Ciry) (State7 �Zip COGe)
7g�. 7-�o d��� 3os st� z . l�.ss c�,,�(��n,Q�, mu�cA�
PRINCIPAL BUSMESS TELEPHONE NUMBER CELWIAR TELEPHONE NUMBER EMAIL ADORESS��/�
Pursuanl b Ciy Cotle Section 2-082(M1)(1)(a)'. A ptl^upal of any wryo�alion, patl�rs�ip, or oMe�eMily wl�o appxars as d IObbyisl m Ee�elf of�M1al
rnll�y,w11hoW speciai compewafion o�reimLurseme�rt fo���e appearance,wlieNe�tlimc(inGirect or con�ingeM,to exD�suppoM1 of or opposNon�o
an pem s�all register wi1M1�M1e QeA as require0 q�iM1is subseclion ON sM1all not Ee�equired to pay any regis�2tion fees.
If the principal is a Corporation, Partnership or Trust, the following infortnation MUST be provitled
pursuan[[o City Cotle Section 2d82�c�: �/� I /�
• NAME OF CHIEF OFFICER,PARTNER,OR eENEFICIARV(if none,wtlte WA�: ���- ^!I� mQL� �-�'V
• NAME OF ALL PERSONS MOLDING,DIRECTLY OR INDIRECTLV,A 5%O/R� MORE OWNERSHIP INTEREST IN SUCM
CORPORATION,PARTNERSHIP OR TRUST(if none,write WA): � I "\
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V�
III. ISSUE TO BE LOBBIED:
� Describe with as much deWil as is p2ctical, including but not IimiMd to a specific tlescription where
applicable of a pending request for proposal, invitation to bid, or publie heari�g number.
C�.�-1�-w�l A�r���^S �otru.�— -�ro�/ iVl [ 4w�i, (Y IU.Si c, I�i'6�e c�
IV. CITY AGENCIESIINDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)�4), list the Cky Commissioner or City personnel sought to he
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
wRh the City to the present date,stating the general nature of the subject contractual relationship.
Full Name ot Indivitlual and Contnctual Relationship(It yes,explain) VeS NO I
Title af Person to be LobbiW
4-� YS I
- . __. _ __—__.___ ___ _.._....__._ �
Pursuant to City Code Section 2�82�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 identffied on the lob6yist registration torm 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):
� No compensation
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i
The following su(6)quesfiona MUST be answered:
. 1) Pursuant�ro CM CoOe Section 2�488,entitletl'PrMi�i[etl Campai9n Coninbutions By LODEyisls On Pmcurement Issues"�.
Yas ✓No: A 1 bb ' o t e d b'd f a otl ent or sarv"ces or on a oreaent or
— — o al yd lo a � t � e9
2) Pursuant to Ciry Cotle Section 2490,entitletl 'Prohibitetl Gampaiqn Contnbutions By Lobbyists On Real Estate Developmem
Issues':
Ves �lo: A O 1 bbVl ntli f 4 f aD¢ I MA reem¢ t 'tht� C'N aD If 4
( Iw f tl ' n Ton or chanae ro Ne C'N's Future Lantl Uae Maoi
3) Pursuant to City Code Section 2-082�h�, any person (except �hose exempt fmm the tlefinilion ot 'IobbyisY' as sel foM in
Section 2-081) who only appears as a representative of a not-for-pmfit coryoretlon or en6ry wi[nout speaal compensation or
reimbursement for ihe appearance,whether tlirect or indirect ro express support of or opposition to any item,shall register with
ihe ciry clerk as requiretl by ttiis sec�ion,�ut s�all not be requi�etl to pay any regis[ration fees.
✓Yes No: A V tl bfo - fit m nf tiN wiN t sD ' I ti or
reimbu�semerM1T
4) Pursuant ro Ciry Cotle Section 2�481, ihe tertn "IobbyisP'specifically ea�Gutles the following persons 6cpcvt witnesses who
pmvide only saeMifiq technical or other spedalized informalion or testimony in publi<meetings; any person who onry appears
as a representative of a neighborhootl association withou[mmpensation or reimbursement for the appearance.whether tlirecl,
indirect or contingen4 to ezpress support o(or opposrtion to any item;and any person who only appears as a represenWtive of
noPfor-profit wmmunity based organization for the puryose of requesling a g2nt without special compe^ution or
reimEurse/m entPorNeappeardnce.
Yes �IIo: Are vou orov'tlina onlv sclentific [ec�nical or oNer scecialized intormatlon: aooeari�w as a
reoresenfative of a ne'ahborhootl associaCon witl�out soacWl comoenaation or reimbursemeM or
o t" t-f - itt b d i af ( M o f u ti t vriNout
scecial comoensation or reimbursement7
5) Pursuant to Cily Cotle Section 2i91(1), no campaign consul�an[shall lobby the Clty Commission for a penotl of 12 monMs
bllowing the sweanng in of any elected official(s) for xTom Me campaign wnsultant pmvitletl rampaign consuNng services
wlthin ihe/pas[elecAon cycle. See Sec[ion 2�491 kr more infuimalian.
Ves �llo: H 0 'd d IU 1 to be [ b fM C'N C 'ss'on
vriN'n the oast election cvcle7 H ves olease listthe incumbenl memberlsl oTMe Cttv Commission:
Ves No: If ves has 't been less than 12 moniha s'nce ihe electetl offieiallsl whom vou orovided camoaian
consult'na eeniees was svrom in't
6) Pursuant to Ciry Cotle Section 2i82(ap4p.. a lobbyist who has within the past election cycle pmvitletl campaign wnsu¢ing
services to an incum�ent member of the Ciry Commission(w�ic�lobbyifg activity is nof otheiwise prohibi�etl by Gode secHon
2-091) shall tlisclose such particular service on his/her lobbyist registration brm antl shall ora1N Gisclose such OaRicular
servce before IobDv na��e CiN Gommission at a oublic mee6no
Ves�lo: Mave vou orovided camoa'an consulGna serv"ees to an incumbeM member of the CiN Commiesion
withinthe st le onc cle9lf es IeaselistiheincumDemmem e oftheC' Commissi n:
Ves`�No: tt ves were vou orom'sed or dd vou recelve economic consideration in exehanpe for camoaian
— — consultinu aervicn7
TO6ECOMPLETEDB CIttCLERK'SSTAFFONLY
PnnualR¢gis�rztloniee: [ ]Yesf✓]No AmouMPaitl^S MGRM ��� Da[ePaitl� �� ay
LOEbyisl Ragis4alion Fmm reraivetl antl veriRetl by: �J�
F:�CLER�S4lL\aFORMS\LOBBYISTFORMS�IobbY�rt0.yirtrationPormRevisetl 03-1I�20REG.�oc RevixA03/IS/3030
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VI. SIGNATURES UNDER OATH:
� ON FEBRUARY 28 OF EACH VEAR EACH LOBBVIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNED STATEMENT UNDER OATH LIS7ING LOBBYING EXPENDITURES AS WELL AS COMPENSATION
RECEIVED FOR THE PRECEDING CALENDAR VEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBVIST HAS BEEN ENGAGED TO �OBBV. A STATEMENT SHAIL BE FILEO EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COMPE N DURING THE REPORTING PERIO�.'
i i
_—._ ' ^ .,1.�a; �.
SignaW re of LobbyisC " Oate �� �%
I tlo solemnly swear or affrm that all oF the foregoing facts, statements, and disclosures in this fortn are irue and cortecl,
antl that I have reatl or am familiar with the provisions mntained in Chapter 2, Art. VII, Division 3, entftled "Lobbyists" oi
[he Miami Beach Ciry Cotl�e an¢cC�ffIIJ�/�or g requirements.
SignatureofLobbyist l//j�- ` � Date �/3�/���
SignaNre of PrincipaC f/y.�—� ��� Date if /���
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: I PRINCIPAL '
Stafeof T��ifavd.lt Sqteof ��.D✓���
Counry of:�n��� 6/� County W: �K^'�� '���.
Swom to or affi�ed)and subscribetl hefore me, Swom to or aff�r^ed)and subscribetl before me,
by means(of8�physical presence by means(of Plphysical presence
or O onlin notanzation, �U�y � ,�G or O online notarvation, y
this 31 3�day o(� .2lyC Oy fhis�day of�20�rby
L.e� r' Sor�Ka hNna B ( iwials
NAME OF LOBBYIST NPME OF PRINCIPAL
�Prod�cedio �L D��✓er �c '�ProtlucetllDF�A- �y�2�7�fl
FORM OF IOENTIFICATION • FORM Oi IDENTIFICAiION
_Personally Known _Personaly Know
���
Signa ure of NOWry ublic SignaNre of ot ublic
�a'FncK L' l�'� !1 a� I We..�woi1�
Name of Notary,Typed, Printed or Stamped Name of Notary,Typed Printed o�Stamped
(NOTARY (NOTARY S
+�• v.raiao:xry
'� �"'�. vmaryauSirz�Neteo'rma� .+A�°"�'. ldwRENCENEILWENM'dRH
ti � mrsonlnHp95H MVCOMMISSION:IHHR5717
'T�e�ertn"IOGO C S��CSKcallyrBZMiBBS1/i@�WIId4Ah petsons ��d.�,.�;°� E%PIFES:Juna27,Z028
Expert witnesses who provitle onry scientifiq technical or other speciaiizetl information or testimony in pu0lic meetings�.any person who
onty appears as a representative of a neighborhootl assaciation witliout compensation or reimCursement br the appearance, whether
tlirect,intli�ec�or contingent, to express support of or opposition to any item;antl any person who only appears as a representafive of
no4Wf�rofit Community basetl organiza6on fOr the purpose of repuesting a grent without spedal mmpensalion or reimbursement for
the appea�ance.
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i
' ;^, BEACH
Ciry ef Miami Bexh,I]00 Co�.sofion Cemar Drb.e,Ndoml Be«h,Flonda 33139,www.mlamibeachA.gov
Offire of the Ciy Clerk
Rokel E Granado, Clry Clerk CiyClarkBmiami6eachfl.gw
Tel: 305 673741 I, Fox: 305.6737254
NAME OF LOBBYIST: ��- �ZO�_
1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT
Pursuant to Ciry Code Section 2-085(d), the City Clerk shall notify any lobbyist (or
pnncipai) who fails ro fde timely a Lobbyist Fee Expenditure and Compensation Statement
(Statement). In addition to any other penalties that may be imposed as provided in
Section 2-085.1, a fne 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 Trusl 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 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 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 p uant to Section 2-482 of the Miami Beach Ciry Code.
���l� " `"�`--� ��3j,��
Signature of Lobbyist Date
F�CIEF\bPLLNFOPMSILOBBYISI FORMSLa�byi9 N�ibRelqn @im FensM N-11 Pp PEGdu
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