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Esteban Ferreiro/PR Concepts, Inc.m MIAMIBERCH City of Miami Beach OfFce of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM Lobbyist mans atl persons ernPloyed or retained, whether Paid or rwt, by a Principal who seeks to encourage the passage, defeat or modficetion d any ordinance, resdution, action or decision d arty oarnniasioner; any action, d•asion, recortxrrerrdation dthe City hllanager or arty city board or committee; or any action, decision or recommar~tion d arty dty personnel during the time period d the entire decision-rrceddn0 Process on such action, decision or reoomrrerMation that for•aeeably win be heard ~ reviewed, ~71reLobbyl•t•a~hae ~~ eXCI~, specifically includes the prinGpal as well as any employee engaged ' lobbying refer to Ordlrgrnce Z00~-3436. ~ i I-PYI~P I ~~ E~S~-elzt.~ (Last) trrrsi~ a•~•v ~~45~1o s;~ -3(~ ~~r ~~o(~ ~~am~ r ~~ 3 (Number and Street) (City) (State) (~ (~o5~q 3~ •©2~~ Si~ver~ r~on I. LOBBYIST RETAINED BY: ~ ~ Ca~~, s ~~-c. ~a rn NAME OF PRINCIPAUCLIENT: ~ lG~~,--- ~ tl>- .S BUSINESS NAME AND ADDRESS (Number and Street) (City} (State) (Ztp Code) TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) section ff principal is a Corporation, Partnership or Trust 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: LOBBY Issat to be lobbied (Descnbe in detaitl,~. - Itl. CITY AQrENCIE$/INDIVIDUALS TO BE LOBBIED: (Pursuant to city code section 2-4e2(g) include a statemsrtt of the extent of any business, financial, tamitlal, professional or other relationship, giving raise to an appearance of an impropriety, with any City personnel sough to bs lobbied; further, pursuant to City Code Section 2- 482(ax4) include a statement of any contractual relatlonshlp (paid or unpaid) from 12 months preceding the commencement of service of Clty personnel to be lobbied.) or E~.h~l b~,k "~ '' C+ 7~1 ~~0 c,=}I~~l~ ~.11~ I £ ~01 Wd 9 I ~dn 80QZ Cl~~~~:J~?~ Exhibit "A" A Full Name of Individual I Title B An Financial, Familial or Professional Relationshi Matti Herrera Bower, Ma or None Saul Gross, Vice Ma or None Jer Libbin, Commissioner None Richard Steinber ,Commissioner None Edward Tobin, Commissioner See Below Ex lanation Deede Weithom, Commissioner None Jonah Wolfson, Commissioner None Jor a M. Gonzalez, Ci Mana er None Jose Smith, Ci Attome None Explanation: Commissioner Edward Tobin had acquired my services of Advertising & Public Relations (Spanish Language Radio Ads, Mailers) for his recent campaign to the City of Miami Beach Commission. Our agreement was for a period of 90 days Maximum which has expired since November 10"', 2007. IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) '.~ " ~~~- B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). 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": ,~' Yes ^ No: Are you lobbxing on a present or cendina bid for goods. equipment or services. or on a present or cendina 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": ^ Yes ~O: Are you lobbying on a cending application for a Development Agreement with the Citv or application for chap of zoning map designation or change 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 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 deck as required by this section but, shall not be required to pay any registration fees. ^ Yes ~o: Are vqu representing a not for-profit corooration or entity wittlout special compensation or reimbursemenk . V. SIGNATURE UNDER OATH: Signature of Lobbyist: Signature of PrindpaUClient: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID ~~--# r ~oo ' ~-' 7~~ 3°~ ^~PfodUCea ID ~~~ ~~ ~ U - ~~ -7 ~ ~ a/ .. c~ Form of Identification Form of Identification ^ Personally known ' a~••r•.~....~..,.~ Personally known (Principal) s~~PY F%~; LILL.IAN BEAUCHAMP VII. 31GNATURE AND ION # DD 530416 .o$F~~~April 29, 2010 ; ~~;J,~,, f "Q:~ ` Bonded 1'hru Nottry PuWE UtMerwrlters =~: -° State of Florida, County of of Florida, i Swom t nd subscribed before me Swom and subscri Sn~ This day of 2008 This L~day of ~^ < Si ature of Publi Notary -State of Flori 5i nature of Public otary -Stet Notarization of Lobbyist's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Reglstretlon fee: [ ]Yes [ ] No Amount Paid S MCR ~ ate Paid Lobbylat Registration Fonn received and verified by: F:\CLER\UOBBYIST\Lobbyist Registration Form 32708.doc Revised 03/27/2008 I do solemnly swear that all of the foregoi g cts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 ~,th~ I~frli Beach City Code and all reporting requiremerrts. Notarization of Principal's signature