Victorina Jimenez/CABI 301 Residential LLP
DEC-01-200B FRI 04:58 PM Shutts and Bowen
FAX NO, 3053819982
p, 01
e MIAMIBEACH
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 nat, by a prinopal who seeks to encourage the passage, defeat
or modlnc:atlon of any ordinance, resalutlon, don or decision of any commi55ioner; any actiOn, declsion, recommendation of the
City Manager or any oty board or committee; or any action. declslon or recommendation of any dty personnel during the time
period of the entire decision-making pnxess on such action, decision or recommendation that foreseeably will be heard or reviewed
by the at'( commission, or a city board or committee. The tenn specifically indudes Itle pr1ndpal as well as any l!mployee 61!JiJ!led
in lobbying actMties. The term "Lobbyists" hilS lipedfic: exclusions. Please ...fII.. bli Ordinance 2004-3435.
NAME OF LOBBYIST:
Ji ~"eL
(last)
'V i l. {Z)/i VI a
(First)
(M.I)
~tu~ I PL ~J/'
tate) (21p Code)
"JieJYl(!tAl'Z @ I'AwlOtfp. awt
E!MAIL: .
_~)~}a~
TELEPHONE NUMBER:
L LOBBYIST RfiAINeD BY:
'~ ~oLJesidMtl&J-LLP
NAME OF PRlNOPAL/CUENr:
EMAIL: (Optional)
Fill out this ledion if princ:ipill is a Corporation, Partnership or TnlIit [Sec:tion :I-4S:I (c:)]
· NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
J4Cobo C4 b.:i b\e
· IDENTIFY ALl. PERSONS HOLDING, DIRECTlY OR fNDIRecrI.Y, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNef{SHIP OR TRUST:
E\\tlS e4 t;xJ.lO\ e j 1\b1l \14\M (4 ba biC ,
a't\Ai~~rCIl'f..VM~1N ontjV'}acllt'e ve"{JQf'~"'" Mew btruc.bc~ gs, o~ .&~'l4.....e.
~ art" o~ i\ll &.w.1IV'l~~al ()l.r~
l$ue to be lobbied (Describe In detail):
In CI1Y ACiENCIES/INDMDUALS TO BE LOBBIED:
A) Full Nilme gf Indlviduill/11t1e
B) Any Flnanciillt Filmiliill Dr Profeaiunill RIlliltionlihip
DEe-01-200B FRI 04:58 PM Shutts and Bowen
FAX NO. 3053819982
P. 02
I
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSAnON (DISCLOSE WHETltER HDURLY,
Fl.A T RATl! OR OTHER):
A) LOBBYIST OIs6.0SURE: (RequIred) f'1~ t--- ~~rti. -1~~, _N.o~.PL- C-o tJt ?~LD-!
B) PRINCIf'AL'S 9ISCLOSURE (OF LOBBYIST COMPENSATION): (Required), Np~~~ JO'(U1f"..tt... ....n+~ tJo~ oJ..
he foil . : fo' b d voiJl.r~~~ L
T oWlng!n nnation must e answere :
1) pursua~t to Miami Beach CItv Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
Ii Yes ~ A~ YO'" lobbyin9 on ill oresent or Dendina bid for DOods. eDuioment or serviCBS. or on ill
Dresent or oendinD award far DoDds. eauioment or servics?
2) Pursua~t to Miami Beach City Code 2-490 Entitled "Prohibited campaign Contributions By lobbyIsts On Real
I::state Development Issues":
!
DYes
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 noHor-profit
corporation or entity without $pec:iill compensation or reimbursement for the appearance, whether dIrect:, or
indirect, to express support of or opposition to ilny item, shillJ register with the derk as required by this
sect! but, shall not be requIred to pay any registration fees..
3)
Dr reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT T
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES,
RECEIVED, IN THE erN Of MIAMI BEACH FOR THE PRE~EDlN
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDrrU
REPORTING PERIOD.
ignature of Lobbyist
I do solemnly swear that all of the foregoi
familiar with the provisions contained in
requirements.
Signature of lobbyist:
Signature of Principal/Oient:
VI.
LOIBYIST IDENTIFICATION:
IJ Produced ID
/ Fann of Identification
~rsonaJlY known (Lobbyist)
THE CITY CLERIC A SIGNED
WELL AS COMPENSATION
NDAR YEAR. A STATEMENT
OMPENSATION DURING THE
facts are true and correct and that I have read or am
n 2-482 of the Miami Beach Oty Code and all reporting
PRINCIPAL IDENTIFICATION:
n Produced ID
Fonn of Identification
/ 'DDJ'AiJ"I'lOt:':::HiI . ','''''J,
~rsonallY known (Principal) 600('; ',('; '}fVW :sHdvj, __-',,~\~.1?);';',:-
6 . -j! Y'-~
t-SIItaa# UO!SLU()J~ :,:' ':'0~
~-. .~-
Z;:lTl?ZUO!) ;JIT"I,,; "::?.:irj ..,:i...<::>/
~ , t.., ~ " 'I~'~I~~'''''
State of Florida, County of Miami-Dade
Sworn and subscrl me
This ~day of /20010
FOR CLERK'
Annual RaglstratJon fee: [ ] Yes [ ] No Amount Paid
LobbyISt RegIStration Form received and verified by:
F:\CLER\$AI.L\MARIA-M\lObbVist\LDBBYIST fORM
U~ON~ ~ ~
MCR 1# Date Paid \2.14 n to
'()_D I I
~L~ 1'1 :;J. 'Pre Revised 12/08/04
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