Lakya Herrera/Rosa Martinez
(9 MIAMI BEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRA TI~. FORM
r
Lobbyist means all persons employed or retained, whether paid or not, y a 'ndpal who seeks to encourage the passage, defeat
or modification of any ordinance, resolution, action or decision of an~'ssioner; any action, decision, recommendation of the
City Manager or any dty board or committee; or any action, decisio or ommendation of any city personnel during the time
period of the entire decision-making process on such action, decision or mendation that foreseeably will be heard or reviewed
by the dty commission, or a dty board or committee. The term specifically indudes the prindpal as well as any employee engaged
in lobbying activities. The term -lobbyists" ha. specific exduslons. Please refer to Ordinance 2004-3435.
~~
NAME OF L BBYlSf: (Last)
CA?oc~~~ ~
SINESS NAME AND ADDR S (Number and Street)
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(First) (M.I)
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(City) l (Sta') (Zip Code)
QC1 a tt-CVf~~n~l\ : .net-
EMAIL:
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L LOBBYIST RETAINED BY:
420tSA AMcer1 f\)~
NAME OF PRlNCPAL/CUENT:
045 6~l:Jo~\MAJ ~ f1... ~l41
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(~J.ta.G~- '()qJg (~19b1- 6722 ~p.:I~r4rtez@ St1tt~l.net
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAlL: (Optional)
Fill out this section I' prJndpalls a Corporation, Parb1ershlp or Trust [Section 2-482 (c)l
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
· IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A SOlo OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUSf:
U. SPECFlC LOBBY ISSUE:
J;:>.e0 nOO(bllct.P~( V17nr1lt- (J~~m'I'1IUm (4..:i~rtt:4') IVl ~ ~I
Issue to be lobbied(Describe in detiJ):'"'
m. CITY AGENCES/INDIVIDUALS TO BE LOBBIED:
..
A) Full Name of Jndlvldualrntle B) Any Flnandal, Familial or Professional Relationship
M~<<~~ 6~ ~.f:=S\6,(J
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) ~t?l::L ~ .
B) PRlNCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). 'ft..iB. ~ / tro~.
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";
DYes 'ANO: Are you lobbvinG on a Dresent or pendinG bid for Goods. eauiDment or services. or on a
I aresent or PendinG award for Goods. eauiDment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By lobbyists On Real
Estate Development Issues":
)Ves D No: Are you lobbvina on a D8ndinG aDDlication for a DeveloDment AGreement with the CitY or
aDDlication for chanGe of zoninG maD desiGnation or chanGe to the City's Future Land Use
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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 derk as required by this
section but, shall not be required to pay any registration fees..
o Yes X'NO: Are vou rearesentinG a not-for-Drofit corporation or entitY without soedal comaensation
or reimbursement. . .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHAU 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 CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTINGPERIOO. ~
re of Lobbyist
I do solemnly swear that all of the foregOin~ facts ue and correct and that I have read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYISTIDEN~CATION:
=z:RIN PAL DE~ON:
. f ,.., . J/ /3f:~;'-tff.7/f-D
roducedID J~ I~y ,
Form of Identification
D Produced ID
Form of Identification
It. Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
o Personally known (Principal)
nty of Miami-Dade
. re me
20t>'
.. ..-...
. D ,.l{,iiRRY HERNANDEZ
',0< It,1\llC~MiSSION # DD 175491
. = A ,jIJ!l(PIRES: May 3, 2007
.;: 2~TtlnJ Notary Public Underwriters
tate of Florida
Nota zation of Lobbyist's signature
FOR CLERK'S USE ONLY ?~
Amual Registration fee: [ Yes [ ] No Amount Pllid I~ - MCR # . ~ --(GfLDate Paid Io~ oto
Lobbyist Registration Form received and verified by: ~
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM o5:1mC Revised 12/08/04