Alexander Heckler/Pedro Munillam Pd,'A.~JJBEACH
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 princpal who seeks to encourage fie passage, defeat
or modification of any ordinance, resolution,, action or derision of any commissioner; any action, derision, recommendation of the
Gty Manager or any dty 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 dty commission, or a cit)~ 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.
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NAME OF LOBBYIST: (Last) (First (M.I)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RE{T~AINED BY:
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NAME OF PRINCIPAL/CLIENT:
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code
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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:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
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Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
B) Any Financial, Familial or Professional Relationship
N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FL.4TRATE OR OTHERJ:
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A) LOBBYISM DISCLOSURE: (Required) ~b °- ~~.~ j- fi~f)Ur Qfi'A1~~
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYISTCOMPENSATION): (Required}. a1~- ~'~J~ l~r h.o"ir~ tr',~Pi~~
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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":
~J'es D No: Are you iobbyina on a present or pending bid for goods, equipment or services, or on a
present or pending award for goods, equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes d~(Na: Are you lobbving on a pending application for a Development Agreement with the City or
application for chance of zoning map designation or chance to the Citv's Future Land Use
Map?
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 anot-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 No: Are you representing anot-for-profit corporation or entitvuwithout special compensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SH L SUBMIT TO TH CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EX EN ITURES, AS LL' S COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRE EDING CALEN /tIR AR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EX END U R CO, PE S TION DURING THE
REPORTING PERIOD. r ~
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Signature of Lobbyist
I do solemnly swear tha~ all of~e fcy.~going fad are tr~ie and correct and that I have read or am
familiar with the provisio~is cont~frhecl'in'.'~ection -482 of ~I~e Miami Beach City Code and all reporting
requirements. ~ ~ V F / /
Signature of Lobbyist:
Signature of Principal/Client:
YI. LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Lobbyist)
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SIGNATURE AND STAMP OF NOTARY:
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State of Florida, County of Miami-Dade
`~ Q Sworn to and subscribed befor me r
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~ "' Signature of u is Notary -State of Flohd
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m ~ Notarization of Lobbyist's signatu
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* ~ Annual Registration fee: ~ ]Yes [ ] No Amo
Lobbyist Registration Form received and verified by ~
F:\CL`=R\~ALL\MARIA-M\Lobbvist\LOBBYIST fOR ~ QS.doc
^ Produced ID
Form of I
j MELISSA WIAfi~ OEIf 1YD0
~~(Personally known (Princi '" ®`~ ~'~MMISSION a~DD5~413~-
~ ` ' .~~ EXPIRES: APR 18, 2010
Bonded through tst State Insuranoe
State of Florida, ~ f Miami-Dade
Sworn d su scrib d e me
This~day ~ ~ ~ , 20~~
Signature of Publi nary - Late of Florida
Notarization off' P rncipal's 'gnature
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Paid