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Yvette N. Harris - Jeffrey Friday VC-4- C=.12-Pro RECEIVED Office of the City Clerk APR -6 ZOZZ 1700 Convention Center Drive CI jar OF Miami Beach, FL 33139 MIAMI BEACH 305.673.7411 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 foreseeably 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. Instructions: Please complete all sections of this form and submit the completed form,with the applicable fee,to the Office of the City 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 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 filed throughout the period that the lobbying occurs. Separate registration forms shall be required or_each principal represented on each specific issue. . LO YIST I F M TI • °, p p( l LiCrL 1 C NAME 0 LOBBYIST • (Last) � "��Il 'rst) (Middle Name) 3.3 (31 - k LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) tat (Zip Code) -% 91 LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS old r.4 II. PRINCIPAL INFORMATION: /1-ti 0-- • J-EFF-E-pi o \-1 ,NAME OF PRINCIPAL (Last). ( (First) ( (Middle Name) l I 1 ICJ fQrreJ fucks-a Rtc? vicu PRINCIPAL BUSINESS NAME AND ADDRESS (Number an Street) (City) (State) (Zip Code) C96/ XO a(c., 7,r- 20/ jeFe 15-Pfu dorcs ce PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS ursuant(b(gCode Section 2-482(h)(70 a): / • ei••1 C2CliV corporation, partnership,I i'C1DL'p n• -••-• m a lobbyist(i)UAIEIRc2S5 without special compensation CP rei .ursement for(BD r•• - - • direct,indirect,t7i'contingent,int23. 01ERACVai,o.•osition( . Di).Taiil dads ]the @U @ re.uired(+D7 subsection 1 dnbD one• L�17re•uired 231317 an fi If the principal is a Corporation, Partnership or Trust, the following information MUST be provided pursuant to City Code Section 2-482(c): • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write N/A): 7-fifth .FR_ I 011-ti • NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR,MORE OWNERSHIP I TEREST IN SUCH CORPORATION,PARTNERSHIP OR TRUST(if none,write N/A): TE-frk° biCy Page 1 of 5 III. ISSUE TO BE LOBBIED: Describe with as much detail as is practical, including but not limited to a specific description where applicable of a pendin request for proposal, invitation to bid, or public hearing nu er. llaanCiCe. NI 6\4- -Rotivk 1/C 1 =to suppurt. 6 e_ e Z2- etfcd / 6/ac% fi/fri f:e r{i U IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(a)(4), list the City Commissioner or City personnel sought to be lobbied, and whether the lobbyist has entered into any contractual relationship (paid or unpaid) with said City Commissioner or City personnel from 12 months preceding such commencement of service with the City to the present date, stating the general nature of the subject contractual relationship. Full Name of Individual and Contractual Relationship (If yes, explain) YES NO Title of Person to be Lobbied (a ivo gee ek V c u- 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 N/A): Al/1+ 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): Page2of5 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 o: Are you lobbying 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 f : Are you lobbying on a pending application for a Development Agreement with the City or application for change of zoning map designation or change to the City's Future Land Use Map? 3) Pursuant to City Code Section 2-482(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 city cler s 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 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 reimburseme or the appearance. _Yes 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 the past ction cycle.See Section 2-491 for more information. Yes Have you provided campaign consulting services to an incumbent member of the City Commission within the past election cycle?If yes,please list the incumbent member(s)of the City Commission: _Yes No: If yes, has it been less an 12 mont since the elected official(s) whom you provided campaign consulting services was sworn iiT 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 before lobbying the City Commission at a public meeting. _Yes 17' Have you provided campaign consulting services to an incumbent member of the City Commission within the past election cycle?If yes,please list the incumbent member(s)of the City Commission: Yes No: if yes, were.you promised:or die you receive economic consideration in exchange for campaign _ _ ---conssultingTices2 — — — TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: Yes[ ]No Amount'Paid$ ��` CC) MCR# C1 9 6 Date Paid ��h ' o Lobbyist Registration Form received and verified by: F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist'Registration'Form Revised 113-1120 iREGrdoc Revised 03/11/2020 Page 3 of 5 VI. SIGNATURES UNDER OATH: 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 PRECEDING CALEND R YEAR WITH REGARD TO THE SP CIFIC ISSUE ON WHICH THE LOBBYIST HAS EENG ED TO LOB . A STATEMENT SHAL FILED EN IF THERE HAS BEEN NO :::: 4iON O MPE AT DU IN THE REPORTING PERI D. a P� Date (�S_1 lJ`Z ,9 ___. I do solemnly swear or affirm that all of the foregoi g facts, statements, and disclosures in this form are true and correct, and that I have read or a familiar ith the provis ons contained in Chapter Art. VII, ivision 3, entitled "Lobbyists" of the Miami Beach Ci Co e:and all orting re it ments Signature of Lobbyist: Date r OQ Signature of Principal: Date 2G 2 VII. NOTARY SIGNATURE D SEAL: LOBBYIST: PRINCIPAL State of FLOR-10.0- State of C A 11 F�.N; A • Ai County of: f t W 1. 4DE . County of: L A cI "3 te s e Sworn to(or affirmed)and subscribed before me, Sworn to(or affirmed)and subscribed before me, by means ell physical presence by means of lEr physical presence or 0.online notarizatiopi or 0 online notarization, this (7 day of f'�P/i/ , 2t by: this y�`day.of A p s-; 1 ,20�, by WYiy%1e- ri,S _)e '�'r,,...1 Gib �Zo.-� NAME OF LOBBYIST NAME OF PRINCIPAL Produced ID. F L_ b L.. Produced ID CA I)r t.e r',f L i c•e h J e FORM OF IDENTIFICATION FORM OF IDENTIFICATION Personally Kno _Personally Known I .I ature otary Public Signature of Not ublic ,)oN„,�,.l A . V i I I e d 0 ,,9 J Name of Notary,Typed,Printed or Stamped Name of Notary, Typed, Printed or Stamped C P )vc 1- t'.- . A• -'rac L E z,• JOHNNYA.VJLLALOBOs (NOTARY SEA ;�� (NOTARY SEAL) ,._.._ .'+ ;.: JASONSALVATORE I �� s. Notary Public-California " tr: MY COMMISSION#NH 000062 3 -�J� ' Los Angeles County > IA.' lk-;$7.: EXPIRES:September14,2024 Y`wrmt.,„.= Commission#2358513 „ I '.f:t„'' _ . . , `„„o="' My Comm.Expires Jun 16,2025 The term lobbyist' s. —__._._ _,-:, a,�:.,,,L,•. 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 reimbursement for the appearance. Page 4 of 5 CALIFORNIA JURAT GOVERNMENT CODE § 8202 A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California County of Los • Aviae).21 Subscribed''lI � and sworn to (or affirmed) before me on this `�+ day of A P r I , 20_22_, by `Date Month Year (1) ,.Fe cce.el Ro i Fr a , tu:: :"Ihndihd."4"16111111"161161.0.-',.°:`.4, JOHNNYA.VILLALOBOS i , f� Notary Public•California (and(2) ), _ Los An�e(es County Name(s) of Signer(s) � � Commission r`2358513 My Comm.Expires Jun 16,2025 r proved to me on the basis of satisfactory evidence to ' be the person(s)who appeared before me Signature Place Notary Seal and/or Stamp Above Si ure of Notary Public OPTIONAL Completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: «*—cALI i 1 e-eJ iJ Fr c.t,-a.. rime-,_ Document Date: Number of Pages: Signer(s) Other Than Named Above: ©2019 National Notary Association MIAMI BEA H City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachf.gov Office of the City Clerk Rafael E. Granado,City Clerk CityClerk@miamibeachfl.gov' Tel: 305.673.7411, Fax: 305.67 .7254 NAME OF LOBBYIST: aiLf l 1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT Pursuant to City Code- Section 2-485(d), the City Clerk shall notify any lobbyist (or principal)who fails:to file timely a Lobbyist Fee Expenditure and Compensation Statement, (Statement). In addition to any other penalties that may be imposed as provided in Section 2-485.1, a fine of $50.00 a day shall be assessed for Statements filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the e 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. 2) LOBBYIST WITHDRAWAL . 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 registrati of all lobbyists shall be required for each 12-month period comm ncing October 1 of ea h year, and the fee for such annual 'registration shall be $500.0 pursuant to Section 2 482 of the ' each City Code. ature of obbyi ) ate F:ICLERI$ALL1aFORMSILOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc ' Page 5 of 5 7 Miscellaneous Cash Receipt crt OF timot BEACH" % No 429960,. , .s LZ Cash ❑Credrt-Card Check# t r , `- °--- YF aiwd of { .. r.-t '. ilAisce�llllaneou5 10ICR=20 r f , n'vr1D:kAAawia f+ ' �rh 14r€ t t s tc I ?' .1 For .. , « V t r'! r (:- Payment Amount 850.00 (THIS INFORtiAllOtt MUST BE.COMPLETED) Omc of Rolm*DJr.Ctar Account Numb.r: r T)I N: O, ' t. is 7c '- .', • ,�, - ., v r - S ;.'`-r!��Rfir:.-3 g t�,,p,'- .it. t, lr•:' iipt - p - <. 3 • r___