2024 Lobbyist Registration Form - Workshops and Presentations (Dr. Rachel Tourgeman) We�lcsb�s � �c�sc��,�wws
� RECEIVED
MIAMI BEACH OffceoftheCiTyClerk ��AY 29zoz4
1700 Convention Center Drive
Miami Beach, FL 33739 CITY OF MIAMI BEACH
305.873.7411 OFFICE OF �'HE CIT'OLEPK
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not by a pnncipal who seeks to encoura9e the passage, defeat or
modifcation of any ordinance, resolution, action or decision of any commissioner; any action, tlecision, recommendation of the Ciry
Manager or any City board or wmmittee;or any aclion, dedsion or recommendation of any City pereonnel during Ihe time perioC of the
entire tlecisian-making process on such action, tlecision or recommendation that kreseeably will be heard or reviewetl by the City
Commission, or a Ciry boartl or committee. The term specifically inGutles the pnncipal as well as any employee enga9etl in lobbying
adivities. The tertn "Lobbyisf' has specific excWsions. Please refer to Ciry Code Chapter 2, AM1icle VII, Division 3, entitled "Lobbyists,"
for atltlitional informalion.
Instmctions: Please complete all sedions of this brm and suDmit Me completed Porm,wi�h ihe applicable fee,to the Office of the Ciry
Clerk. If you need more space ro complele an answer, use a separate sheet(s) of paper. If you have nothing to report in a parlicular
section, you must wnte 'none' or "Na" in that sectiort Any change to any information originalry fled, or any atltlitional Ciry
Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amenOment to the regisiration form.
The lobbyist �as a continuing duty to supply information antl amend the fortns filed fhmughout ihe penod [hat ��e lobbying occurs.
Separate registration forms shall �e required for each Onndpal representetl on each specific issue.
1. LOBBYIST INFORMATION:
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NAME OF L08BYIST (LasQ (Flrs�) (Mitltlle Nartre)
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LOBBVIST BUSINE55 NAM PNO ADORESS (NumOer antl SheeQ (Qly) (Stat ) (Zip COCe)
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II. PRINCIPAL INFORMATION:
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NAMEOFPRINCIPAL (LasQ (Pirsi) (MitltlleName)
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PRINCIPALBUSINESSNAMEANDADORESS (Num�erandS�reeQ (C��y) �a�e) (Zi CoOe)
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PRINCIPALBUSINESSTELEPHONENUMBER CELWLARTELEPHONENUMBER EMAIL DDRE S
Pursuam ta Ciry Code Sedion 2d82(h)(1)(a): A pnncipal of aM�W�non, paMership, or M�er er�tiy who appears as a loobyist on Oe�alf of Ihat
mtity,vnlhoul special mmpensation or reim�ursemeM for ihe appearance,whelher Oired,intlirecl,or contl�gent,la ezpreas wpporl of or opposi�ion�o
en Rem shall register vailM�e CIeM as requiretl by Mis subseclian but shall noi�e requireE fo OaY erry,egistrztion 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 CHtEF OFFICER,PARTNER,OR BENEFIC�ARV(if none,write WA�:
. NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLYQ,A_5%cO1R' M� O�,OWNERSHIP INTEREST IN SUCH
CORPORATION, ARTNERSHIP OR TRUST(if none,write NIA): \\0'-cM�c I 4�1 a'q� Pi..��� _��
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III. ISSUE TO BE LOBBIED:
Describe with as much deWil 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.
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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 contrectual relationship (paid or unpaid) with
said City Commissioner or City personnel from 72 months preceding such commencement of service
with the City to the present date, stating the general nature of the subject cont�actual relationship.
Full Name of Individual and Contrectual Relationship (If yea,explain) YES NO
Title of Person to be Lobbietl
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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 �elationship, 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 identKied 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 ANO AMOUNT OF LOBBYIST COMPENSATION — Be Soecific. (Note that a
contingency fee is prohibited pursuant to City Code Sec. 2-085.3�:
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The following siz(6)questions MUST 6e answeretl:
1) PursuanS to City Code Section 2-488,entitled"Prohibited Campaign Contnbutions By Lobbyists On Procurement Issues°'.
Yes �'NO: Are vou I bb 'na o a ore t entll a b'tl f ootls eau o t or se ites ofese t o
pend a rd for aooCs ea ' t or xrvice?
2) Pursuant to Ciry Code Section 2J90, entitletl "Prohibifed Campaign ConMbutions By Lobbyists On Real Estale Development
Issues": �
Yea vNo: Are vou lobbv' a n a centlina aool' Con for a De eloo t Aareeme t 'th th C'N or aool'wli
t chanae oTzon' a ao tleslanatio�o cha ae to the C'N's FuWre Lantl Use Mao?
3) Pursuant to Ciry Cotle Section 2-082�h), any person (except thou exempt from [he definition of 'IobbyisC as set forth in
Section 2-481)who only aDPears as a representative of a not-for-profil corporation or entity without special compensation or
reimbursement for the appearance,whether direct or intlirect ro express support of or opposi6on to any item,shall registerwith
the city cle as required by�his seclion,but shall nol be required to pay any regishation fees.
_Ves o: Are Vou o es nlina e ol f -o ft tOfoo af entlN 'th t Dec'al w ce li of
reimbursementP
4) Pursuant to City Code Section 7-487, the term "IobbyisP' specifcaliy ezdudes the following persons Expert witnesses who
provide onty sdentific,technical or olher specialized infortnffiion or testimony in public meetings; any person who only apDears
as a representative of a neighbortiood association without compensation or reimbursemerrt for the appearance,whether direct,
indirect or contingen; ro express support of or opposdion to any item�,and any person who only appears as a repreuntative of
not-for-profit wmmuniTy baud organizatian for ihe pmpose of requesting a grant without special compensation or
reimburse ent for the appearance.
_Ves�: Are vo 0 0 'tl'na onlv sc'entific technical or other scecialized informatlon: aooearinn as a
oresenbtive oi a ' h6 rhootl assoc at'o 'tho t scec'al c oensatlon or re mbursement or
reoresenUna a t(o -orofit basetl o o ' ation for Ne n oose of reauest' a a oraM wtthout
soec al comcensalion or reimbursement9
5) Pursuant to Ciry Code Seclion 2.191�1�, no campaign consultant shall lobby t�e Cdy Commission for a penod of 12 months
foliowing the sweanng in of any elected otficial(s) for whom the campaign consutlanl provitle0 campaign wnsultlng services
within the st election cyGe. See Sec[ion 2-09'I for more information.
_Ves�: Ha e V ro 'tletl Ce D ' S Itlna se ' t an 'ntumbe t mbef Of the C'ri C 'B 'on
within t�e oa t election cvcle9lf v olease Ilstthe'ncum6eM membeHsl of the Cttv Commissian:
Yes No: �� has it been lesa Ltin 12 oMhs since Ne electetl otficlallsl who 0 orovitletl w oa'�n
' — consultlrw xrvices was awom In9
6) Pursuant to Ciry Code Sec[ion 2J82�aN4�a., a lobbyist who has within the past election cyGe pmvidetl campaign consulting
services to an incumbent member of the Ciry Commission (which lobbying adiviry is not othervnu prohibited by Cotle sec[ion
2-491) shal�tlisclose such partiCular service on hislher lob�yist regisiration form antl shall ofallv 0'Sclose such oaMCular
rvi ce ber6re IOEbv na ihe C'N omm ss on al a oubl'c meetina.
Ves o: H ou orov'ded amoalan consulCna serv'ces to an incum6ent member oi the CiN Commiss'on
'th' th oast elect'o vcle7lT vea olease I'stthe incu be t embeHsl oT the C"N Commission�
Yes No: If v were vou oro ' ed r tlitl vou rece've economic consitleratlon in exchanae for camoalan
— — consultlna services]
TO BE COMPLETED BY CITV CLERN'S STAFF ONLV
Annual Repiatretion fee: [ ]Ves N]No Amount Paitl S�MCR t�' S � �' Daro Paltl S 2�1 1
lobbyiat Regiatration Fomi roceiv E antl vedfletl Cy: � �
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VI. SIGNATURES UNDER OATH:
ON FEBRUARV 28 OF EACH YEAR EACH LOBBVIST 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 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 COMPEN�JSATI/O/�N�DURING THE REPORTING PERIOD.'
SignatureofLobbyist . /�a.-/GY �" Date .� /2� ��-o�-`F
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I do solemnly swear or affrm that all of the foregoing facts, statements, and disclosures in this fortn are tme and correc[,
and that I have reatl or am familiar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of
the Miami Beach City Code and all repo�rtinng requiremen[s.
Signature of Lobbyist �!�/J�.n..K�G � Date �I�--f� � �.oZ?°
SignatureofPrincipaC /7.. C�..�G(/ �w.�A-..--�---� Date -t/ 1.i' � Z�'�--`�
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of �� State of ! �
Counry of: M C�t+.� ' � ' County of: �{.iW��= - ��.C�
Sworn to(or affrmetl)and subscribed before me, Swom to(or affrmed)and subscribed before me,
by means of O physical presence by means of� physical presence
or O online notarization, or�online notarization, �J
this a�day of 1�1,a-/ .20��by this�day of M�20M!6y
JZrn�I.`.I ��P.�n D�e�il.al Tovco,F.�r,
NAME OF LOBBVIST NAME OF PRINCIPAL
� ProducedlD��'�K`3 ��Le�".� �ProducedlDDr��`� � �G°+`�-
FORM OF IDENTIFlCATION FORM OF IDENTIFICATION
_Personally Known Personally Known
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Signatu�e of Notary Public Signature of Notary Public
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Name of Notary, Typetl, Printed or Stamped Name of Notary, Typed, Printed or Stamped
(NOTARY SEAL) +",'"�j�OMP.RQU�"*,,, (NOTARY SEAL) � ,,,,,, ,
d��P:�
jx.Oi�tPµYPUg[i:, •,`., �,•OPt\pRYP�G�
C'•.
' ,;�O Bli�;, .
' The tertn"lobbyist"speufwlry e clupe�E� reon� : ,
` ' c�FIFES 42� '• ° ' '
Expert witnesses who prwide onl�scierl[Ifc. techmcal o�o pedalized information or testimony in public eetir� M a
only appears as a representative � ' orhood . � - n w,thout compensation or reimbursement fo he;appea� ,�iqi
direct, indirect or contingent, to exp �u �b�p ., ion ro any item; antl any person who only appe '_ representa
not-for-proft community basetl organi , �' pt�e of requesting a 9rant vnthout special compensatl �t$iLa�r��,�
the appearance. �,...��,��••"" "'-���
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MIAMIBEACH
Cily ef Mami Beoch, V00 Convenfion Cemer Drive,Miami Beach,FloAda 33139,www.miomi6eachA.gov
Office of tha City Clerk
Rofoel E. Granodo, City Clerk CityClerk�miamibeachFl.gav
Tel: 305.6737411, Pox: 305.6737254
NAME OF LOBBYIST: ����� T V�qC',hna61
1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT
Pursuant to City Code Section 2�85(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 Tile 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 fle 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
$ 00.00 pursuant to Section 2�82 of the Miami Beach City Code.
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S . �� � ���
Signature of Lo ist Date
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