2024 Lobbyist Registration Form - Breast Cancer Awareness and Prevention (Jane M Piazzetta) _� ... _ ._
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RECEIVED
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. �. �s $. ���*-5'*-.� � �� Office of the City Clerk
1700 Convention Center Drive
Miami eeach, FL 33139 CITY OF MIAMI BEACH
305-6737411 OFFICE OF THE GTV CLERK
L08BYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whelher paid or noL. by a principal who seeks to encourage Ihe passage, de�eat or
modi�ica�ion of any ordinance, resoWtion. ac�ion or decision of any commissioner; any action, decision, recommendation of the Ciry
Manager or any City board or commitlee;or any action. decision or recommendation of any City personnel during ihe[ime period of ihe
entire decision-making process on such action, decision or recommendation �hat toreseeably will be heard or reviewed by [he Ciry
Commissioq or a Cily board or commitlee. The �erm specifically includes the principal as well as any employee engaged in lobbying
activities. The �erm 'LobbyisP' has speciFlc exdusions. Please refer b City Code Chapter 2. Article VII, Division 3, entitled "Lobbyists,
br additional informa�ion.
Instructions: Please complele all sections ot this torm and submi��he completed�orm,with Ihe applicable fee, to the Office of Ihe City
Clerk. If you need more space to complete an answer. use a separate sheeqs) of paper. I� you have nothing b report in a particular
sec�ion, you must write "none" or "n/a" in lha� sec�ion. Any chanqe to any in�ormalion originally tiled, or any addi�ional City
Commissioner or personnel who are also sought to be lobbied shall require ihat the lobbyist file an amendment to the regis[ration form.
The lobbyis� has a continuing duty �o suppty information and amend the �orms filed Ihroughou� �he period tha[ Ihe lob6ying occurs.
Separate rec�istration brms shall be required for each principal represented on each specific issue.
I. LOBBYIST INFORMATION:
P;a��ena Jane/Janinha "'
NAMEOFLOBBVIST (Las�) (Pvs[) (MlddleNama)
H3'. HEALTH. HOPE HEALING. 1935 CALAIS�RIVE.#205 MIAMI BEACH FL 33141
LOBBVISTBUSINESSNAMEANDADDRESS (NumberantlS�reeti (Clly) (Slale) (ZipCode)
305-53L20A6 �86-314-9009 jp@h3hope org
LOBBVISTBUSMESSTELEPHONENUMBER CELLULAFTELEPHONENUMBER EMAILA�DRESS
II. PRINCIPAL INFORMATION:
Plezzetta Jane M
NAME OF PRINCIPAL (Lagt) (Pirs�) (Mltldle Name)
H3:HEALTH. HOPE. HEALING 1935 CALAIS�RIVE,SUITE 205 MIAMI BEACH FL 33141
PRWQPFIBUSWESSNAMEANDADORESS (NumberandSheel) (GI�y) (Sla�e) (ZlpCode)
305-53L20A6 ]863]4-9009 info@h3hape.org
PFINGIPALBUSINESSTELEPHONENUMBER GELWLARTELEPHONENUMBER EMNILADDRESS
Pursuanl lo Ciry Code Section 2-482(h)�1)(a): A principal of any corparation. patlnership, or other entity who appears as a lobbyist an behalf oi�ha�
entity,without special compensa�ion or reimbursement for the appearance,whelher tlirect,intlirect,or contingenl,to express supporl ot or opposition fo
an item shall regis�er with�he Clerk as required by Ihis subsection bui shall no[be requiretl[o pay any regishalion fees.
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided
pursuant to City Code Section 2-482(c):
• NAME OF CHIEF OFFICER, PARTNER,OR BENEFICIARY(i�none,wri�e N/A): N�A
. NAME OF ALL PERSONS HOLDING, DIRECTLV OR INDIRECTLY,A 5%OR MOfiE OWNERSHIP INTEREST IN SUCH
CORPORATION, PAFTNERSHIP OR TRUST(if none,wrife WA): N/A
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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 public hearing number.
H3 requests financial support to increase visibility and expand programs in our diverse South Florida communities
This support is essential throughout Ueatment providing comfort and quldance to�hose alonq the survivors'
lournev Our oroqrams include� H3 Ooen Panel Discussion about Cancer H3 Pink Ribbon Podcast H3 Pink
ir� �
Ribbon Support Program and FREE Mammogram Services Expansion. �O YI"C �ferSl�Fii1�X{A"warc✓It SS �
`�r�Ua��'J ln .
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 fhe present date, stating the general nature of the subject contractual relationship.
Full Name ot Individual and Contractual Relationship (If yes, explain) VES NO
Title af Person to be Lobbied
; SS� N
Pursuant to City Code Section 2-482(g), every registrant shall be required to sfate the extent of any
business, financial, tamilial 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 itlentified on the lobbyist registration form filed.
List any Business, Financial, Familial or Professional Relationship, or o[her relationship giving rise to an
a earance of im ro riet if none,wri[e N/A :
N
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):
IV�Nl�— — —
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The following sin(6)ques�ions MUST be answeretl:
1) Pursuant b City Code Sec�ion 2-488,enlitled'Prohibitetl Campaign Con�ributions By Lobbyists On Procuremenl Issues':
Ves xNo: A vo lobbv' a o se t o oe d' o b'd fo aootls ea 'o t o se �c oresent or
pentlinq award for 000ds equipment or service?
2) Pursuanl to Ciry Code Section 2-490, en�illed 'Pmhibited Campaign Contributions ey Lobbyis�s On Real Esta�e Development
Issues":
Yes xNo: A v I bbv a o a oe d' o ool'cat o fo D I n e t Aa ee t 'ih the Citv o ool' t
f r cha ae of o � a o des q at o o h u to ihe C'tv's Future Lantl Use Mao�
3) Pursuant to Ciry Code Section 2-462(h), any person (excep� Ihose exemp� fmm Ihe de�inition of "lobbyisf' as set forth in
Section 2-481) who only appears as a represen�ative of a nobforpmfit corporation or en�i�y withou� special compensation or
reimbursemen�for[he appearance,whe�her direcl or indirect�o express support of or opposition to any item, shall regisler wi�h
ihe ciry clerk as required by this sectioq but shall not be required to pay any regis[ration fees.
x Y¢S NO: A V fEp ES2 l� O hf0 -DfOflt CO W C EOYfV �IhO t p¢C al COmDC C O
reimbursemen�7
4) Pursuant to City Code Section 2-481. �he term "IobbyisP' specifically excludes Ihe following persons Expert wimesses who
pmvide only scien�ifi0. �echnical or other specialized information or teslimony in pu6lic meetings; any person who only appears
as a representa[ive of a naighborhood associafion wi�hout compensafion or reimbursement for[he appearence, whether direct,
indirect or con�ingen�, �o express support ot or opposi�ion�o any item;and any person who only appears as a representalive o�
nobfor-profit community based organization for lhe purpose o� requesting a gran[ wi�hout special compensation or
reimbursemenl for the appearance.
xYes_No: A e vou o �d' a only sc'eni fc techn'cal or other soec'al'zetl information� aooearino as a
rep ese taf t a neiqhbo hood a oc'ation 'thou[ so 'al compe safo re'mbursemenl or
ep e t a a nohfo -o of't 6 d orqa ' al'o f th p rpose of a ['nq a q a t 'th t
soecial compensa�ion or reimbursement?
5) Pursuant to Ciry Code Sec�ion 2-491(1), no campaign consWtant shall lobby [he Ciry Commission for a period o� 12 months
following the swearing ln of any elected offlcial(s) tor whom the campaign consWtant provided campaign consulting services
within lhe past election cyde. See Sec�ion 2-491 for more intormation.
Ves xNo: H v p o 'detl ca o �a �[' a se ' t 'nc mbent member of ihe Citv Comm'ss'on
'th' the oast elect v I � Ii ves olease I' t the'ncumbent member(s)of the C'Iv Comm'ss'on:
Yes x No: Ii ves h 't been less th 12 monihs s nce the elec[ed off�c'al(s) whom vou orovided camoaiqn
consultino services was sworn in?
6) Pursuant�o Clry Code SecUon 2-482(a)(4)a.. a lobbyist who has withln the past election cycle provided campaign consWting
services lo an incumbent member of thr. Ciry Commission (which lo6bying activily is not otherwise pwhi6ited by Code sec�ion
2-491) shall disdose such particular service on hisiher lobbyisl registretion �orm and shall orallv d'sclose such oarticular
'ce befo e I bbv a th G't Co t bf tl o.
Ves x No: Ha e vou o o 'd d mpa'o co s It o 'ces to bent member of ihe Citv Comm'ss'on
'�h' th o st elecYo cvcl � It v olease I'sl the'ncumbent member(s)oi the Ci�v Commission:
_YesxNo: �� �a� we e vou o o � d or d'd vou rece've econom'c cons'deration in e:chanoe for camoaion
consultina services?
TO BE COMPLETED BV CITY CLERK'S S,TAFF ONLV
Annual Registration fee: � ]Ves�No Amount Paid$�MCR N N�� Date Paid ��4��Z`�
Lobbyis�Registra�ion Form recerved antl vertlietl by Q r�rC��,n .
^.�Ctek ,. �,h+s`toaun .��rtray,t; G �r� e ��neG.<io: Revised03111/2020
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VI. SIGNATURES UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNED STATEMENT UNDER OATH LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATION
RECEIVED FOR THE PRECEDING CALENDAR VEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN E AGED TO LOBBV. A 5 ATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO
EXPENDITURE OR COM ENSAT N NG E OFiTING PERIOD.'
Si nature of Lobb ist. / / / C Date_ �5 z� _
I do solemnly sw a r afl ri m at all of ihe fore facts, statements, and disclosures in this form are true and correc[,
and Ihat I have read or am f miliar wi� he pr � � ns contained in Chapter 2, Art. VII, Division 3, entitletl "Lobbyists' of
the Miami Beach City Code nd all re rting quirements.
Signature of Lobbyist Date �O �9 ZO Z .
Signa[ure o� Princi I: Date 0 �9 �L�
VII. NOTARY SIG TURE AND AL:
LOBBYIST: PRINCIPAL
State of �' �OC�C�,q State of "f �06�(�.G
Counryof: F-�;c.M� �d'�- Coun�yof: N�GKI� �7r9.�
Swom to (or affirmed) and subscribed before me, Swom to (or affirmed) and subscribed before me,
by means of�.physical presence by means of,�physical presence
or 0�o�nfJ,n�e notarizati9L or � online notarization.
ihls 1"F � day of JV A�2CL�, by ihls��ay of —�20�, by
�512. �Gc�a Q��7�E�«'n �(al�2 1'�ci.f:Q iC1j,Z�.�C�
NAME OF LOBBVIST NAME OF PFINCIPAL
x ProducedlDl-�l- P2���53�3� J�ProducedlDp2'SJ�S3-�- �iT3-�
FOFM OF�DE(J3 ICA�N FORM OF IDENTIRCATION
��j�A,
Personall Known _Personally I nown
�Siya o ary Mic �
+'�, �� La���t1�7 . 5�-�ce Lci�c:<-9,�
Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Prin�ed or Stamped
(NOTA ) � nuces.�nvnoo (NOTARYSEAL umes.uvaoa
:/j��i. MYCOMMISSION#HMPI2560 f a� �\ MVCOMMISSION#HH2]2580
��' IX%FES:JUN O6,2026 IXPIPES:AIN Ofi,2026
�'� EI$IBIBIOAIIRIIEB �� e0114LdNN1��16I$�E[BIMYIIOCB
' The term "lob ry'ERCIIIbes-tli2'ft11 owing persons:
Exper�wilnesses who provide only scientifiq lechnical or olher specialized informalion or lestimony in public meetings;any person who
only appears as a representative of a neighborhood association without compensation or reimbursement for Ihe appearance. whelher
tlirect, intlirect or contingenL to express support of or opposition to any item', and any person who only appears as a representative of
noPfor-pmfi� communiry based organization for the purpose of requesting a grant withou� special compensalion or reimbursemenf for
Ihe appearance.
Page 4 of 5
Ciry of Miami Bea<h, V00 ConvenHo�Cenier Dri�e, Mlami Beach, Flarida 33139,www.miamibeachfLgov
Offlce of fhe Ciy Clerk
Rafoel E. Gmnado, Gly Clerk CityClerk@miamibea<hA,gov
Teh 305.673J411, Pox: 305.6737254
NAME OF LOBBYIST: Jane M Piazzetta aka JANINHA
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 penaities 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 wiih 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 conciuded or I am no longer lobbying on
that issue, I shall immediately file a Notice of Withdrawal with the Offlce of the City Clerk.
3) ANNUAL LOBBYIST REGISTRATION FEE
I u erstand annual registration of all lobbyists shall be required for each 12-month period
c mencing October 1 of each year, and the fee for such annual regisiration shall be
0.00 pursuan Section 2-482 of the Miami Beach City Code.
a 7 I5 �02
i nat e of Lo yis � Date
rrc�aseu,ar-'oan�s�oeeris�Foan�s��noersi ap�s�no�co�m ae��sao os i i zo eee aa
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