Raul de Quesada/Fox PanAm
~~
,
.-OJ
t'(ECE\VED
City of ~Caead, Bffi~dfthe City Clerk
1700 Conventi~~E1~~~~r<~.ri~~Ni~i Beach, FL 33139
LOBBYIST REGISTRATION FORM
tD
.........
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 "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435,
31D. 444. 9 b/'1
TELEPHONE NUMBER:
!!au-I
(First) (M.!)
/440 S - Se vi v( tI~ .$/v{.. :#d-TJ- Ios./ht e/ls c..4-
(Number and Street) (City) (State) ( . Code) '700 J...S
~/tJ. 444. j 44=l- ra vI. ~e Q {;Ie s; ~ ch Q -(0 ~ , C!. OM
FAX NUMBER: EMAIL:
de. QVE.S4 ~A-
NAME OF LOBBYIST: (Last)
:fo 'I- 0 rf~ :J:;, Ie r f'l a. -I- h:Jl1a
BUSINESS NAME AND ADDRESS
I, LOBBYIST RETAINED BY:
F 0 Y- t C(/) 4-. t"'\e..(' / C.a /I ..r fJ t) ri s
NAME OF PRINCIPAl/CUENT:
(F,P.A.sj
lOb 14 Iv _ S'a/V\pk. .eel. S-I-c. c2 00 ~Dra / Sfr /,/ltJ's, ~L 3 3ob~
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
q ~ f., .~.> 5. K to (, S' tf S 4-= ::; S S. '-:1- 3 T , C4 rd C/l ~ ..s fL. ...{Yr ~ f v. Co /)-'l
TELEPHONE NUMBER: 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:
.::J4/Y1 (. oS 64. " Ie f
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
flfA
6ra/lf
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
I /Vl1
gee; (II,
is-I--/- 0 r
f} u-t AI) r i I-
CCI\vel\!;0
IV, DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
. A). LoBBYIST DISCLOSURE: (Required) /}) /4-
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). H./A
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 ~. Are YOU lobbyinG on a oresent or oendinG bid for Goods, eauioment or services, or on a
oresent or oendinG award for aoods, eGuioment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes ~ Are YOU lobbyinG on a oendina aoolication for a Deyelooment AGreement with the City or
aoolication for chanGe of zoninG mao desiGnation or chanae to the City's Future Land Use
Mao? .
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..
D Yes ~Are YOU reoresentinG a not-for-orofit corooration or entity without soecial comoensation
or reimbursement, .
V, SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO. THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CAL D R YEAR. A STATEMENT,
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES 0 0 ENSA N DURING THE
REPORTING PERIOD. ,.-- ~
I do solemnly swear that all of the foregoin
familiar with the provisions cant
requirements.
Signature of Lobbyist:
are true and correct and that I have read or am
82 e Miami Beach City Code and all reporti"g
LOBBYIST IDENTIFIC
Signature of Public Notary Sta
Notarization of Principal's si
D Produced ID
/ Form of Identification
~ersonallY known (Principal)
o Produced ID
Form of Identification
, Personally known (Lobbyist)
SIGNATURE AND STAMP OF NOTARY:
FOR CLE
Annual Registration fee: f-"1 Yes [ ] No Amount Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc
, US!> ONLY "'2~r-t _
C!::> MCR #' . -'-lO~\O Date Paid \~6/0~
Revised 12/08/04