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,,/\i AM I BEACH Office of the City Clerk NO V 2;4 2021:
1700 Convention Center Drive
• Miami Beach,FL 33139 - CITY OF ILIA I BEACH- 305.6,73.7411. OFFICE OF THE'CITY CLERK
LOBBYIST REGISTRATION FORM
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 foreseeabiy 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'Lobbyist has specific exclusions.Please refer to City Code Chapter 2,Article VII,Division 3,entitled'Lobbyists,'
for additional information.
pp-
Instructions: Please complete all sections of this form and submit the completed form,with the applicable fee,to the Office of the City R
Clerk. If you need more space to complete an answer,use a separate sheet(s)of paper. If you have nothing to report in a particular
section, you must write 'none' or 'n/a' in that section. Any change to any information originally filed, or any additional City
Ij Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amendment to the registration form.
The lobbyist has a continuing duty to supply information and amend the forms fired throughout the period that the lobbying occurs.
Separate registration forms shall be required for each principal represented on each specific issue.
I. LOBBYIST INFORMATION: . •
I b M°S . pLAV I Pr • ' Lb 12_ N
NAME OF LOBBYIST - (Last) (First) (Middle Name) -' _
ilkAt41 Vol hall
CeSU ( 3�"4 St �{n
3°b �'anni
LOBBYIST BUSINESS NAME16ND ADDRESS (Number and Street) (City) I �����
(State) (Zip Code)
(3K) t133— ((15- -
oItuna@ ooc dco •ca)-%;\
LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS
• II. PRINCIPAL INFORMATION; ^
Deal OS DIA°t Pc L012.6n
NAME OF PRINCIPAL (Last) (First) (Middle Name)
I IA0CV Uo'k YAV ba,2Q 6�'b N(; 39 St33qa� rill M Ft33139- =
PRINCIPAL BUSINESS NAMED ADDRESS (Number and Street) (City) (State)
(Zip Code)
3bSti1/;3 b O litA a@oocuo o coliv,
PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS •
Pursuant(b City•Code e.on 2T48-2Zh)(1)(a). A princ pal of EIT corporation,partnership,(p(21:1?entity whoa CO0 IobpyistZ:it behalf ortiatf.
er�U C ual)co pensatio t7/rembursement for(ljipappearance,itIc1207 direct, 09contingent to express supportofaoroppositionto
•
an itemshalr register„withfithe Clerk as required byrthis subsection but shall not be required to pay any registratIon fees
If the principal is a Corporation, Partnership or Trust, the following information MUST be provided
pursuant to City Code Section 2-482(c): I
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write NIA): D l I V I(A 0(tMO.S
• NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR//M�� iR MOREOWNERSHIP INTEREST IN SUCH
CORPORATION,PARTNERSHIP OR TRUST(If none,write NIA): - CI 1 t_V i C.‘.
6o,..)
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III.ISSUE TO BE LOBBIED: T•,
N
Describe with as much detail as is practical,including but not limited to a specific description �1
applicable of a pending request for
Mb a1 .,1 a Pe proposal,invitation to bid,or public hearing number.P on where 1
v`C,1 Y bad ,juY r►�xlv v a-o I� t-
a
ic
•
IV.CITY AGENCIES/INDIVIDUALS TO BE LOB V BIED:
Pursuant to City Code Section 2-482(a)(4), list the City Commissioner or City
lobbied, and whether the lobbyist has entered into any contractual relationship
said City Commissioner or Cityrom 12 moP personnel sought to be
with the City to the present dat ,stating the general nature of the subject contractual commencement at relationship.
• Full Name of Individual and l Contractua Relationship(If yes,'explain) Mil
Title of Person to be Lobbied
rn1am1 4 e h v.
111111111111111.11...
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‘, • ,.I , !
1111111111......1111111
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Pursuant to City Code Section 2-482(g), every registrant shall be required to state the extent of any
business, financial, familial or professional relationship, or other relationship giving rise to an
appearance.of an impropriety,with any current City Commissioner or City personnel who is.sought to
be lobbied as identified on the lobbyist registration form filed.
List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an appearance of impropriety(if none,write NIA):
NIPiV , .
V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION-Be Specific.(Note that a
contingency fee is prohibited pursuant to City Code Sec.2-485.3):
NI PC
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The following six(6)questions MUST be answered: • -
1) Pursuant to City Code Section 2-488,entitled'Prohibited Campaign Contributions By Lobbyists On Procurement Issues":
•
~ _Yes ANo: Are you lobbvinq 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 City Code Section 2-490,entitled'Prohibited Campaign Contributions By Lobbyists On Real Estate Development
Issues':
_Yes o: Are you lobbying on a pending application for a Development Agreement with the City or application
TT for change of zoning map designation or change to the City's Future Land Use Map?
3) Pursuant to City Code Section 2482(h), any person (except those exempt from the definition of'lobbyist'as set forth in
Section 2-481)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 ci ler(as required by this section,but shall not be required to pay any registration fees.
Yes o: Are you representing a not-for-profit corporation or entity without special compensation or
a r reimbursement?
4) Pursuant to City Code Section 2-481,the term"lobbyist"specifically excludes the following persons: Expert witnesses who
provide only scientific,technical or other specialized information or testimony in public meetings;any person who only appears
as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether direct,
indirect or contingent,to express support of or opposition to any item;and any person who only appears as a representative of
not-for-profit community based organization for the purpose of requesting a grant without special compensation or
reimb ement for the appearance.
_Yes No: Are you providing only scientific, technical or other specialized information: appearing as a
representative of a neighborhood association without special compensation or reimbursement or
representing a not-for-profit based organization for the purpose of requesting a grant without
special compensation or reimbursement?
5) Pursuant to City Code Section 2-491(1),no campaign consultant shall lobby the City Commission for a period of 12 months
following the swearing In of any elected official(s)for whom the campaign consultant provided campaign consulting services
within h past election cycle.See Section 2-491 for more information.
_Yes o: Have you provided campaign consulting services to an incumbent member of the City Commission
within the past election cycle?If ves,please list the incumbent member(s)of the City Commission:
_Yes o: If yes, has it been less than 12 months since the elected official(s)whom you provided campaign
con u ling services waS.sworiiAn2
6) Pursuant to City Code Section 2-482(a)(4)a.,a lobbyist who has within the past election cycle provided campaign consulting
services to an incumbent member of the City Commission(which lobbying activity is not otherwise prohibited by Code section
2-491) shall disclose such particular service on his/her lobbyist registration form and shall orally disclose such particular
service fore lobbying the City Commission at a public meetinq. _
_Yes o: Have you provided campaign consulting services to an incumbent member of the City Commission
(((I within the past election cycle?If yes,please list the incumbent member(s)of the City Commission:
•
-.Mt•_'i•_tea
•t Yes o:• If ves, were you promised or d d you receive economic consideration exchange for campaign
$ .
co nsultingCs rvM?
Y `
_TO BE COMPLETED BY CiTY•6ERK'S STAFPONLY-'
Annual Registiatiori fee: [ ]Yes[']Nov Amount Paid$ t o[ire^ MCR# - *r ; 'Date Paid
x,. ..,r '*- r- -.,r -•.c,A,.^ir.; 44b 4'sP v.`.M6,.}Y",4tir, r.=:.. ,,, s t.;. 4,410-4*, -
Lobbyist Registration Form received and verified.by:•,-4 -- - +
F:\CLER\SALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Farm Revised 03-11-20 REG.doc •3 r>>. Revised 03/11/2020
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VI. SIGNATURES UNDER OATH: t---1
ON FEBRUARY 28 OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A
SIGNED STATEMENT UNDER OATH LISTING LOBBYING EXPENDITURES AS WELL AS COMPENSATION
RECEIVED FOR THE PRECEDAM CALENDAR Y• • - WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE
LOBBYIST HAS BEEN - • • 171/.0 LOBBY. 7� TEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO Q
EXPENDITURE OR C 4,4:iviTTT,�ijDURING—u d..PORTING PERIOD? `
VS•
Signature of Lobbyist:AM��7�� Date 1v� I t9L'( 9-V-
I do solemnly swear or affirm th- - of the foregoin• -a �,statements,and disclosures in this form are true and correct, G
1 i and that I have read or -- - _
th the prov' I. s ••ntained in Chapter 2,Art.VII,Division 3,entitled"Lobbyists"of
the Miami Beach Ci� ode a ; - I ortin• -qui - ts.
Signature of Lobbyist ���,,,`l�j�4 Date I�� - ��\ 0�1
Signature of Principal: �K/�Pr','i_ Date ! 3 L'{ 2.-�• _( '
VII. NOTARY SIGNATURE AND SEAL:
1 LOBBYIST: PRINCIPAL
State of V�I1O Y1 ' State of r 10 Y\
„r I County of: Da�i County of. ep . --
Sworn to(or affirmed)and subscribed before me, Sworn to(or affirmed)and subscribed before me,
by means offiphysical presence by means of Vphysical presence
,ii or 0 online notarization, or 0 online notarization,
this Zy day of I.)@v.0nh r� .2021,by this lac. day of N n•J•- A19-.o r ' :20Zt by
�IV�G Or rYloS O Iv i a () rn-t o
NAME OF LOBBYIST NAME OF PRINCIPAL
1, /'Produced IDf'IoxidA brivecs LiCL..s'k /Produced ID Flo ridaOr(vcts L'0..e,s-Z
FORM OF IDENTIFICATION FORM OF IDENTIFICATION
Person ly Known 1 _Personally Known
�Llcn J rt.Gtc�.
Sin re of Notarylic Si a�
g g t e of Notary Pu lc
$mil!-i �L v°Jc 4. P3 cl -C G-L,-Q • Q( .
Name of Notary,Typed,Printed or Stamped _. Name of Notary,Typed,Printed or Stamped
•
r . , (NOTARY SEAL) I :i�,�..,' DELKIGUEVARA a I . (NOTARY SEAL ,
I ( 15)t Notary Public-State of Florida I xptz
Acii DEIKI GUEVARA
Notary Pub
i t ,���M1r Commission@ HH 075I51 I ry lic-State or Florida ' ,
{ S My Comm.Expires Dec 28,2124 I , �?\\\�°r� Commission s HH 075251
'The term"lobbyist"specifi I My Comm.Expires Dec 28,2124
d ' ,
{ Expert witnesses who provide only scientific,technical or other specialized Information or testimony in public meetings;any person who
only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether
{ direct,Indirect or contingent,to express support of or opposition to any item;and any person who only appears as a representative of
1 not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for i
the appearance.
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City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www•
I Office of the Gtv i.tc CitvClerki fmtamloeacnn.or
Rafael E.Granada.City Clerk
I Tel:305.673.7411.Fax:305.673.72a-
'c
1On11,0
NAME OF LOBBYIST: 1 1I�� & f•M s
1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT +'
Pursuant to City Code Section 2485(d),
the City Clerk shall notify any lobbyist (or
principal)who fails to file timely a Lobbyist Fee Expenditure and Compensation
imposed ti providetatemen d nt .
(Statement). In addition to any other penalties that may
Section 2-485.1, a fine of$50.00ta day shall Miami-Dade Dade County Commission e assessed for s on Ethics rand� ��
due date. The City Clerk shall notify .
Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the
assessed fines after notification. '
Any lobbyist, who fails to file the required Statement by April 30th of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust. .
I hereby acknowledge that on February 28 of each year, I shall submit to the City Clerk a
signed Statement under oath listing all lobbyist expenditures, as well as compensation
received,for the preceding calendar year with regard to the specific issue on which I have
been engaged to lobby. i.
1 2) LOBBYIST WITHDRAWAL
1 '
Once an issue I have registered to lobby has concluded or I am no longer lobbying on
that issue, I shall immediately file a Notice of Withdrawal with the Office of the City Clerk.
3) ANNUAL LOBBYIST REGISTRATION FEE
I understand annual registration of all lobbyists shall be required for each 12-month period
commencing October 1 of each year, and the fee for such annual registration shall be
$ .00 pursuant t• -.tion 2482 of the Miami Beach City Code.
dr/ i
tkv • Z';laba-I
Signature of Lobbyi-, Date
F:ICLERl3ALL1aFORMSLLOBBYIST FORMSLLcbbyisl RegWmUon Form Roviood 03-11-20 REG don
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