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HomeMy WebLinkAboutGonzalez Alfredo/ Mango's Mi8nli ...." W 2lIUJ lQ - - 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 during the time period of the entire decision-making 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 term specifically includes the principal as well as any employee engaged in lobbying activities. The term "'Lobbyiststr has specific exclusions. Please refer to Ordinance 2004-3435. Gonzalez Alfredo J. NAME OF LOBBYIST: (Last) (First) 1221 Brickell Avenue Miami, (M.I) Florida 33131 BUSINESS NAME AND ADDRESS 305-579-0588 TELEPHONE NUMBER: (Number and Street) 305-961-5588 FAX NUMBER: (City) (State) gonzalezaj@gtlaw.com EMAIL: (Zip Code) I. LOBBYIST RETAINED BY: Mango's Tropical Cafe, Inc. NAME OF PRINCIPALjCUENT: 900 Ocean Drive BUSINESS NAME AND ADDRESS 305-673-4422 TELEPHONE NUMBER: Miami Beach (Number and Street) (City) Florida (State) 33139 (Zip Code) FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] . NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: David Wallack . IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Same as above U. SPECIFIC LOBBY ISSUE: Conditional Use and Violation Issue to be lobbied (Desaibe in detail): UI. CITY AGENCIES/INDMDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship Planning Department, Fire Department Zoning Department, Planning Dept. Mayor/City Commission/City Manager, Special Master ~~.~O\ t lC ~ .. 'A.7 ~~~~ 'i. (") S' (if i~_I:! 1 ,..., ~ (if CiNar c..J 0 -.. - ~ ""T1 ~ ~ The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": o Yes II No: Are YOU lobbyinG on a Dresent or DendinG bid for GOods. eGUiDment or services. or on a Dresent or oendinG award for Goods. eGUiDment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": DYes XJ No: Are you lobbyinG on a DendinG aDDlication for a DeyeloDment AGreement with the City or aDDlication for chanGe of zoninG maD desiGnation or chanGe to the City's Future Land Use Mu1 3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of "lobbyist" as set forth in Section 2-481 above) who only appears as a representative of a not-for-profit corporation or entity without special compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any item, shall register with the clerk as required by this section but, shall not be required to pay any registration fees.. DYes M No: Are you reDresentinG a not-for-Drofit corDOration or entitY without sDecial comoensation or reimbursement. . v. SIGNATURE UNDER OATH: ON OCTOBER 1 sr 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 PRECED G CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDIT S OR OMPENSATION DURING THE REPORTING PERIOD. I do solemnly swear that all of the for familiar with the provisio co i i requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCPAL IDEN11FICATION: o Produced ID D PrOduced ID Form of Identification Form of Identification ~rsonallY known (Pdjo.Q.MIl....."',_..._... -j l\iATAUE CORPORAN ~ NO';:~.Fr{ PUBUC - 8 fAlE OF FLORIDA ty ,Qf ~ariiijD~fi€'ON #: 0.."024364 I ~~d(&'M~1rSSIO;' [XFli~E$ MAY 9, 2005 -~ X Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed before me This S~ da 20:s;S ~ , FOR CLE~ USE ONLY, rl ~ Annual Registration fee: [ ,~[ ] No Amount p~~ ~ ()J.~ MCR ~8B Date Paid ,J --I '(..."D <. Lobbyist Registration Form received and verified by: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc Revised 12/08/04