HomeMy WebLinkAboutDenise V. Galvez/Easton Bravo
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat
or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the
City Manager or any city board or committee; or any action, decision or recommendation of any city personnel defined in any
manner in this section, during the time period of the entire decisionMmaking process on such action, decision or recommendation
that foreseeably will be heard or reviewed by the city commission, or a city board or committee. The tenn specifically includes the
principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer
to Ordinance 2004-3435.
NAME OF LOBBYIST:
C7ALV'E-.2 DENlSE
(Last) (First) ,(M.!)
,
EAS1DN '6ek\1'D P~~Ns 5~1) vJ L.-\q-S"\-- l-{w-ilfi,..:3e:>ILfD
(Number and Street) (City) (State)' (Zip Code)
5C:>S:: - 2 (Ct -~ 17 d O'\Is..e@f'aS!Ofl/WA:VD. ~
FAX NUMBER: EMAIL:
v.
BUSINESS NAME AND ADDRESS
3os;- '505-(<0(<.0
TELEPHONE NUMBER:
I. LOBBYIST RETAINED BY:
E1\Slbf'.-l6t:'J>NO p,e=ovC.TI ~NS
NAME OF PRINCIPAl/CLIENT:
~
Ilk ".)80 V\J l-jq ~T
BUSINESS NAME AND ADDRESS (Number and Street)
1--1 lAM, I :6b/'.C. t+
(City)
30'S: - 2,S r "y Co -:r..q
FAX NUMBER: (Optionai)
fL
(State)
3 ~ I l-{D
(Zip Code)
5D~ 50S-/'-o Il.::>
TELEPHONE NUMBER:
EMAIL: (Optional)
Fill out this section if principal Is a Corporation, Partnership or Trust [Se~lon 2.482 (c)]
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: f:1--.1 ZA.. 6E"'Ttt EA..S"TD/'J
~,/p.. ~p..VO
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: 'Pe:N6t:O yAL\/f=-2..
II. SPECIFIC LOBBY ISSUE:
'leA.: c..,t2ANT ~
Issue to be lobbied (Describe in detail):
U('IIN 'fVtJIL '\1. v.Sl.c. ferrlV f'<l-
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
vC-/\
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
.....&
-€Y
Y No: Are 0 sentin a not-for- it cor ration or enti with ut s ci I com en ion or
reimbursement. Pursuant to Ordinance No. 2004-3435.
1)
Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach City Code Chaoter 2. Article VII, Division S
Thereof Entitled "Camoaion Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Procurement Issues":
~NO:
Are YOU lobbvino on a Dresent or Dendina bid for Goods. eauiDment or servjce!li. or on a Dresent
or oendina award for Goods. eauiDment or service?
2)
Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaater 2, Artide VII Division S
thereof Entitled "Camaaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camaaian Contributions Bv Lobbvists On Real Estate Develoament Issues":
A 0 lobb in on a ndin a Iication for a Dev 10 ment A m n I h CI or
aDDlication for chanae of zonin~ maD desianation or chanae to the City's Future Land Use MaD?
V. SIGNAT\JRE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTlNG LOBBYING EXPENDITURES, AS WELL AS COMPENSAll0N
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSAll0N DURING THE
REPORllNG PERIOD. ~
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Signature of Lobb .
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisions contained in Section 2- 2 of the Miami Beach City Code and all reporting
requirements.
\,
Signature of Lobbyist:
,/
----
VI,
LOBBYIST IDENTIFICATION:
Produced lD
r1tss Oi/-qi/(.I {, 'I
Form of Identification
PRINCIPAL IDENTIFICATION:
ProducedlD'~ p~ ol/-I/I/'I/'I/
,,_ Form .9(JdJjntification 'J.-l
wx- ~/510 3 - toE - f/~i!/?
Personally known (Principal)
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Swam and subscribed before me
This .:lfLday of ()'T"t-- , 200!f.
ignature of Public Nata tate of Florida
Notarization of Lobbyist's signature
Signature of Public Notary - State of Florida
Notarization of Principal's si9nature
~~. liliam R Hatfjefd
:.~ ; . ~ Commission DDOO2020
..~ - .J[Pl'~s Fellfuary 11,2005
FOR CLERK'S USE ONLY V 0 l'~
Annual Registration fee: [ ] Yes [~ Amount Paid ~ ~(::J MeR # F? ..2~J uate Paid
lobbyist Registration Form received and verified by: ,.
Revised 02/10/04 F: CLER\ALL\MARIA-M\LOBBYISl\LOBBYIST FORM 04
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