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Javier F. Avino/ Brilla AJ RMB, LLC ~ ._, 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 the passage, defeat or modification of any ordinance, resolution, action or deasion 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 deasion-making process on such action, decision or recommendation that foreseeably will be heard or reviewed by the city commisson, or a city board or committee. The term spec~cally includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 20043435. Avino Javier F. NAME OF LOBBYIST: (Last) (First) (M.I) Greenberg Traurig 1221 Brickell Avenue, Miami FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-579-0703 305-961-5703 avinoj@gtlaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Brilla AJ RMB, LLC NAME OF PRINCIPAL/CLIENT: 120 NE 27 Street, Suite 500 Miami, Florida 33137 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 786-375-5600 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this sedaon if principal is a Corporation, Partnership or Trust • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Adam Cohen, Manager • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Luis Benshimol II. SPECIFIC LOBBY ISSUE: , Operating Issues at the Raleigh Hotel Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name ofIndividual/Title B) Any Finandal, Familial or Professional Relationship Building Department Planning Department i ~ j ~ ~ ; ~t ~ , ~ „, t i ,~ City Manager/Commission ~S ~ ~ ~ .. ~~~ .. r; IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHERx A) LOBBYIST DISCLOSURE: (Required) $310.00 Hourly B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $310.00 Hourly The following information must be answered: i) Pursuant to Miami Beach City Code Section 2-488 Entitled 'Prohibited Campaign Contributions By Lobbyists On Procurement Issues": Yes x No• Are you lobbvina on a present or pending bid for goods, epuipment or services, or on a present or pending award for ooods. equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled'~Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": Yes X No• Are you lobbvina on a pending application for a Development Agreement with the City or application for change of zoning map designation or chance to the Citv's Future Land Use Mao? 3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of "bbbyist" 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.. V. SIGNATURE UNDER OATH: ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. ~ _r1 Signature of Lobbyist I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained in 'on 2-482 of the Miami Beach City Code and all reporting requirements. ~•A ,/ Signature of Lobbyist: Signature of Principal/Cli~+nk.J VI. LOBBYIST IDENTIFICATION: Produced ID ~R~ ~S~s~ g ~~ g. !r +M~i Form of Identification Personally known (Lobbyist) SIGNATURE AND STAMP OF NOTARY: of Florida, County of Miami-Dade i to and subscribed before me :2 day_o~ber , 20 09 ~~~~~ PRINCIPAL IDENTIFICATION: 'FL. -~T . L: C~e..rS ~ Produced ID L~ ~ - C~.0~1 ~ 3 _y 5 \ - b Form of Identification _ , Personally known (Principal) State of Florida, County of Miami-Dade Sworn and subscribed before me This 22_-dav 9 ~i°Y-= State of Forida a of Florida ization of Lo byist's signature Notarization of Princi 's signature FOR CLERK'--~NLY nn 9 Registration fee: [ ]Yes [ ] No Amount Paid MCR # V~ ~ [ ~ Date Paid ~ ~ l 0 t Registration Form received and verified by: ~~ \$ALL\MARL4-M\Lobbyist\LOBBYIST FORM 05.doc ,,~,~,~ ~~ D~(!~ Revised 12/08/04 a 1~~ f~~} ~~~t