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Lucia A. Dougherty - Sustone RP Collins k' MIAMLBEACH 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 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 "Lobbyists" has specific exclusions. Please refer to Ordinance 2004 -3435. Dougherty Lucia A. NAME OF LOBBYIST: (Last) (First) (M.I) Greenberg Traurig, P.A. 333 Ave. of the America, 44th Floor Miami FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) alp Code) 305 - 579 -0603 305 - 961 -5603 doughertyl©gtlaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes: address, phone, or e-mail address. LOBBYIST RETAINED BY: Sunstone RP Collins, LLC NAME OF PRINCIPALICLIENT: Sunstone RP Collins, LLC 120 Vantis, Ste 350 Aliso Viejo CA 92656 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust (Section 2482 (c)) • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: I�( �. CzuSG C,RO • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ILSPECIFIC LOBBY ISSUE: � ,i Hotel Renovations . (R. PLAZA , 11' TEL, /Poi G . ,'v S A v f� Issue to be lobbied (Desc in detail): III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2482(ax4) include the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's commencement of service with the city to the present date, stating the general nature of the subject contractual relationship. Sec 2.482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES NO title of person to be lobbied Historic Preservation Board, Board of Adjustment Planning Board City Departments Pursuant to City Code Section 2482(g) Every registrant shall be required to state the extent of any business, financial, familial or pryiessiormil relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner or city personpl who is -- sought to be lobbied as identified on the lobbyist registration form filed. .' Sec 2.482(g) Any Financial, Familial or Professional Relationship 1 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) 5500.00 hourly B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). 5500 on hourly 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 ": U Yes ® No: 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 Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues ": ❑ Yes ® No: Are vou 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 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 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 clerk as required by this section but, shall not be required to pay any registration fees. Q Yes IN No: Are vou representing a not -for -profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON FEBRUARY 28th 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 B FIL ' EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyis I do solemnly swear that all of the foregoing facts are true and correct and that 1 have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code a d all reporting require Signature of Lobbyist Signature of Principal /Client: VI. LOBBYIST IDENTIFI • N: PRINCIPAL IDENTIFICATION: ❑ Produced ID 0 Produced ID s * , Form of Identification Form of Identification -o�, •.�,, 4/ a 1; 9d- Pe rsonally known (Lobbyist) ❑ Personally known (Principal) •1 � "', VII. SIGNATURE AND STAMP OF NOTARY: � z 0 .c o 0. 3 0 Mate of Florida, County of Miami -Dade State of Florida, County of • i -Dade Si a B - worn to and subscribed before me Sworn and subscribed • - • re me m H, m Q "Ipis _ _- _ , 2011 This day of , 2011 =. n __ � I " c o °' ' " '{" *17 ;- State of Florida Signature of • c Notary — State of Florida ep_ a m n • r: rizatlo of • < - • - •• Notarizatio• • Principal's signature o• Ww TN G y A TO BE COMPLETED BY ITY CLERK - TAFF ONLY w • An ual Registration fee. • t% ] Yes [ ] No Amount Paid $ S • 'Y 111 Date Paid ILO - yist Registration Form received and verified by: ild1111=1// F:\OLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registra on • Revised 1/11/2011 1 CALIFORNIA JURAT WITH AFFIANT STATEMENT `- i 4 � i 4 "' --- tl H M M tl �4 'I N N ti N N H �l ' �C. .'\ 5..: �..: ��.¢ �r..\ .,. .\�.f\ ❑ °See Attached Document (Notary to cross out lines 1-6 below) ❑ See Statement Below (Lines 1 -5 to be completed only by document signer[s], not Notary) Signature of Document Signer No. 1 Signature of Document Signer No. 2 (if any) State of California County of 0 Subscribed and sworn to (or affirmed) before me on this t ' { day of fs b , 20 l , by Date Month ear (1) Vieth / — 1-. s , Name of Signer HEIDI TORR proved to me on the basis of satisfactory evidence omissi # Z o e e person who app. ryr • a� Notary Public - California Z Z''' Orange County > (and 1 _ _ _ _ _ My Comm. Expires Jun 30, _20_13A ( — �� Name of Signer proved to me on the basis of satisfactory evidence to be th- persrn who appeared before me.) - w Signa r r- /AA - .dr Signature of Notary Public Place Notary Seal Above OPTIONAL Though the information below is not required by law, it may prove RIGHTTHUMBPRINT RIGHTTHUMBPRINT valuable to persons relying on the document and could prevent OF SIGNER #1 OF SIGNER #2 fraudulent removal and reattachment of this form to another document. Top of thumb here Top of thumb here Further Description of Any Attached Document Title or Type of Document: Document Date: Number of Pages: Signer(s) Other Than Named Above: ©2007 National Notary Association • 9350 De Soto Ave., P.O. Box 2402 •Chatsworth, CA 91313-2402• www.NationalNotary org Item #5910 Reorder. Call Toll -Free 1- 800 -876-6827 MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityClerk @miomibeochfl.gov Tel: 305.673.741 1 , Fox: 305.673.7254 LOBBYIST NAME: Lucia A. Dougherty I understand that no later than February 28th of each year, I must file the following form, pursuant to Section 2 -485 of the Miami Beach City Code, with the City Clerk's Office for all active lobbying issues. 1) Lobbyist Expenditure and Compensation Form Failure to file these forms on a timely basis will result in my name being transmitted to the Miami -Dade County Commission on Ethics and for code violation evaluation. In addition, once an issue I have registered to lobby on has been resolved, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. V / Signature: Date: