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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRA nON FORM
lobbyist means all persons employed or retained, whether paid or not, by a prlndpal who seeks to encourage the passage, defeat
or modification of any ordinance, resolution, action or decision of any commissioner; any action, dedslon, recommendation of the
Oty 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 decision-making process on such action, dedslon or recommendation
that foreseeably will be heard or reviewed by the city commission, or a city board or committee, The term speCifically Indudes the
principal as well as any employee engaged in lobbying activities. The term -Lobbyists" has specific exclusions. Please refer
to Ordinance 2004-3435.
Bcc\o~ yeA. (PC~\ ~.~ l\..l '
NAME OF LOBBYIST: I (Last) (First) (M.!)
~()W ~(}Y) T ovJ~1 I ~11-. PL 1'-1-4/ B neW) 'AJJe- (Vu..~1 ff-
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
~Z)S-S~b~l\ \2 ~~~-S:-?::.I0' \\~ P{)!IoQT~L~ .UlJyV\
TELEPHONE NUMBER: FAA NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Co 1\+'\ '(\U\A.. \'Y\ Co -
NAME OF PRINCIPAL/CUENT:
qO~D\J~ 9o,{\-K 1)y~~, 't\A~~ ~~ RL
BUSINESS NAME AND ADDRESS (Number and Street) l (City) (State) )
3b$"- S~'SLi- - 9,+'6~ 365'-S3~ -"~:1-'R'f ~bv~-sie~~vrtI(\\AUvY\ -so.lyaet,
TELEPHONE NUMBER: FAA NUMBER: (Optional) EMAIL: (Optional) <:0:.""
35139
(Zip Code)
Fill out this section If principal Is a Corporation, Partnership or Trust [Section 2-482 (c)]
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIREffi Y OR INDIREffi Y, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
---'(CO ~'-l-~~ iJn OJJJ ~~ Q.,y\. -tOY &~ ,~S W.s
Issue to be lobbied (Describe In detail): \)
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
C')
B) Any Financial, Familial or Professional Relationship::::; S?
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IV. D1!>CLOSU/l.E OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
$' '2. tf 0 . ()l)
'I> '2-LfO . 00
Yes
ensation or
1)
Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach Citv Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaion Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaion Contributions Bv LobbYists On Procurement Issues":
Yes
nt
2)
Pursuant to Ordin'ance No. 2003-3395 Amendino Miami Beach Citv Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
~~:::~:~:i::ti::Sa B:e::i:~:D:~::~:::e aD:::;::::::::ment with the City or
aPDlication for chanGe of zoninG maD desiGnation or chanGe to the City's Future Land Use MaD?
~G
V.
SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
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 COMPENSATION DURING THE
REPORTING PERIOD. c \
~ ~Signature of Lobbyist
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 com.ined in Section 2-482 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
~.~!
Signature of Principal/Client:
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
Produced ID
Produced ID
Form of Identification
Form of Identification
~rsonally known (LobbyJ;ij)
VII. SIGNATURE AND STAMP OF NOTARY:
Personally known (Principal)
State of Rorida, County of Miami-Dade
Swom and subscribed before me
This _day of . 20_
Signature of ublic Notary - Sta of Florida
Notarization of Lobbyist's signat"re
,,'~ll\~.~ Wilda Montenegro
f:~~<~ COffi!"ission #DD267008
~". ~;g~ Expues: Nav 13, 2007
......;~~~~~~..... ~ftnded Thru
'tt,' lnlUl1li" ,-,-. .,,,\ . Inc.
Signature of Public Notary - State of Rorlda
Notarization of Principal's signature
FORC RK' S ONLY {lZ1f~
Annual Registration fee: ] Yes [ ] No Amo t , MCR # ~ate Paid
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F: C ER\A
OCT-20-2004 18:40
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOB8YJST C:OMPfNSA'I'lON (DISCLOSE WHETHER HOURLY,
, FLAT RATE QIl OTHF./l):
A) LOIl8YIST DISCl.OSURE: (Required) t 2. 'f. () . ()I)
.11) PIUNCIPAL'S DISCLOSURE (OF lOBIlYlST COMPENSATION): (Required)._ ~ '2.. 'fo . 0 0
P.03/03
Yes No: Are YOU reo resentinG Ii not-Ior-orofit camoration or entitv .llIithout saedal coma.nsation or
reimbursement. PUl'SIjant to Ordinanc:e No. 2004-3435.
1) Pur~llant m Ordinance No~ 2nD!-!!'! AmerKtina Miami Beadl {~tv eode Ch~pt~r 2 Artide Vlt. Division 5
Thereof FntirlAd "Clmoaion FinanCl! Reform" Vii! The Addition or COOl!! Section 2-488 Enlitled ~Pmhjbited
CamDaian ContrihuTions By Labbvists On Procuremilnt Issues":
2)
Are YOU lobbvina on a aresent or aendina bid lor Goods. eal,lioment or services. or on a atesent
or oendina award for Doods. eauiDment or servil:lJ?
Pul1'Jllllnt m Ordln'ana!"'o 2003-3395 Amendino MIClml Sea!:h C3tv Cade Chanter 2. Artide VII OivisiM S
thereof Entitll!d ~Campalan FinanCf! Reform~. Via The Addition Of c.'Xle Section 2-490 Enlitled .Pmhibited
CampaiQn Contributions By Lobbvists On Real Estilte Oeyelooment ~
Yes No:
Vas No:
Are vau labbvina on a Dflndina ilDDJication fer a DeveloDmel1t Aareement with the Cilv or
iaaliution for chanGe of zoninG m~D desiGnation or I:hanal1 to the C:itv's Future land Use MaD?
V. liXGNATURE UNDER OATH:
ON OcrOSI:R lSf OF EAat YEAR, EACH LOBBYIST SHALL SUBMIT TO THE C11Y CLERK A SIGNED
STATEMENT UNDER OATH, LImNS 1..0BI\I1NSEXPI:NDITURf'$, A5 WELl.. AS COMPENSATION
Rl:CEJVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDINC:i CALENDAR YEAR. A STATEMENT
SHALl.. BE FIL.ED EVEN IF THERE HAVE IEEN NO EXPENDITURESi OR COMPENSATION DURING THE
REPORTING PERIOD. c I
~
Sign.oture of Lobbyist
I do solemnly swear that all of the foregoing facts are true and l:orrect and that I have read or am
familiar with the provisions cQRtiljQed In Section 2-4B2 of the Mianli Beac/l Clty Code and all reporting
,"","ments. ~
~gna"re" U>bbyI.c t..: ~. 1,;;
Signature of PrinCipal/Client: . ii/ tr e;J, /' U 14 i'\; (v;
VI.
LOBBYIST IDENTIfiCATION:
PRINCIPAL IIJENTlflCATlOn:
Produced ID
Produced II)
Form of Identification
~rsonallv known (Lobb;tD
, .
VII. SIGNATURE AND STAMP OF NOTARY:
Form of Identification
Personally I;nawn (Principal)
Sblte of Floritl3, County of MiamI-Dade
Sworn and sul)$(/'ibed before me
This _ria., of , 20_
Signawre of ic Notary - Sta of Florida
Notarization of Lobbyist's signature
~~.~~ Wilda Montenegro
i ::.0...,', S CDmmission NDD267008
\\.. '!!!)! Expires: Nay 13,2007
"I:;o;~~ !4Q11doj Thm
'.,. ^I.II;I~". . . ~ ..: "" .lnc.
Si!jnature of F'I.Iblic Notary - State of Florida
Notarization of Princ:ipal's signature
FOR Q.ERK'S USE ONLY
Annual Regimatlon fee; ( ] Yes ( 1 No Amount P..ld MClU _ . Date Paid
Lobbyist Reolstratlon Form rlC'liVed and verified by:
Revised 02/10/01 F: CLelt\ALL\MAIUA-M\l.OBIl'ftSl\l.ClBBvtST FORM 01
.
TOTAL P. 03
OCT-ZO-Z004 05:34PM
~
FROM-TEW CARDENAS REBAK
+3055361116
T-339
P 003/003
F-453
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSA'rION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
t 2. 'fo . ()I.)
. A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF lOBBYIST COMPENSATION): (Required).
'$ 7-LfO . 00
Ye.<;: No: Are VOIl rellresentinq a not.for-llrofit corlloration or entity .INithout special compensation or
reimbursement. Pursuant to Ordinance No. 2004-3435.
1) Pur~llant ro Ordinance No. 2003-3393 Amendlno MI.lmi Beam (itv Code Chaoter 2. Article VII. Division 5
Thereof Fntirled "Camoaion Finance Reform" Via The Addition Of C~de Section 2-488 Entitled "Prohibit.<:Q
Camoaion Contributions Bv LobbYists On Procurem!!nt Issues":
Yes No:
Are vou 10bbvinQ on a llresent or oe"diml bid for aaads, eQI"ipment or services. or on a present
or DendinQ award far goods. eQuiprntlnt Or servic~
2) PUr'Sllimt to Ordinance No 2003-3395 Amendino MI.,ml Beach C;ltv Code Chaoter 2. Article VII DiYision ~
thereof Entitled "Camoalon Financ./'! Reform". Via The Addition Of (?de Section 2-490 Entitled "Proh~
Camcai9n Contributions Bv lobbYists On Real Estate Oelleloomentl~
Yes No:
Are vau 10bbv;",1 on a lle"ding alllllicatian for a Developmellt Aareement with the CiN or
aPtllication for chanqe of zoninq millD designation or chanq':1 to the City's FutUre land Use Mall?
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LIsnNG LOBBYING EXPENDITURE:S, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR nn, PRECEDIN(i CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES; OR COMPENSATION DURING THE
REPORTING PERIOD. < I
~ign,"ture of Lobbyist
I do solemnly swear that all of the foregoing facts are true and <:orrect and that I have read or am
familiar with the provisions coAtolilled In Section 2-482 of the Miami Beach City Code and all reporting
",,"i""'''o~, ~
5'go,,,,..ofLD,,,,'''' ~, ~' .,
Signature of Principal/Client: "... '1' /f tr' Ch t'j, (..(w I"V C (/,
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL II,IENTIFICATION:
Produced ID
Produced II!
Form of Identlflcatlon
Personally known (LObb~
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida. County of Miami-Dade
Sworn to and subscribed before me
This () da of 0 c IJ~ 20.S2.:+
'df/...
SignaMe of u ic Notary - Sta of Florida
Notarization of Lobbyist's signature
4~~Y~-- Wild~ Montenegro
: :"""'"\. 0 CommiSSion IIOD267oo8
~~. "':!!i) Expires: No~ 13,2007
"~,"o_iv:r-',' J{ol'ldo..1 nml
-'t. r',d.;.:T.' ,;' ",,\ Inc.
FOR CLERK'S USE ONLY
Annual Registration fee: [ ] Yes ( ] No Amount Paid MCR It _ Date Paid
LObbyist RelJ1stratloo Form received and verified by:
Revised 02/10/04 F: ClER\ALL\MARIA-M\LOBBYISnWBBV1ST FORM 04