Collins Avenue Assoc. LLC
SEN. BY: ~ERCOW & RADELL, PA;
.. .'"
3053778222;
JUL-31-02 2:30PM;
PAGE 8/B
qty of I'1iIrri 8oI.ch omc.. of ltIto Qy Cen:
1700 ~ Cent<< Drtve, MilIml BeBdl, R. 3JU!il
em.l: citrdwkOd.miBmi-b....'h.llu. '
LOBBYIST REGISTRATION FORM
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(City of I'tiami lleacll, City Cod.. a..pter 2. Division 3, SediClll l-481)
e Chel:k Bo1't if .n Amendment
Winston
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Jack
NAME OF LoIIBYIST:
(Firsr:)
(M.ll DATE QUAUFIED AS lO8BTIST
Miami Florida 33131
(SbllIo) (Zip Cede)
200 S. Biscayne Boulevard Suite 1900
BUSINESS ADOf\!ss: (NLInlber and SUaet) (City)
(305) 443-0727 (305) 443-6814
lSJ:PHONE NUM8E~ I'AX NUMBeR:
EMAn.:
Collins Avenue Associates,.L.L.C.
NAME CF PIUNOPAl./alENT':
100 SE 2nd street Miami
IUSINESS AOOIlES!l:
(Number and str....tl (CIty)
(305) 995-5340
F~ lilJf'llleR: (optiQlil)
Florida 33131
(Slam) (ZJp Code)
(305) 995-5330
TELEPHONE NlJMBe~
EMAn.: (Oplianall
Fill _ th. __lI II' prlndpal .. . CDrpaf'lltIon, Partn..nItip or Trust [SaniIJn 2-4112 (~)]
1 NAMEClfc;:Hl!FCFRCEIl, PARTNER, ORllaEfIaAAY: Don Peebles
7 WT ALL PERSOHS HCtJ)fNG, DVlfCTL TOR. IIClIIU!CTlT, A S'lIo 0Il10101l.E OWNERSHIP IPmRfST IN sUCH
CO~IlA' 10/11, PAI{f1\IEIlSHlP OR. T1WST:
11. SP!ar1C LOBB., ISSU~.
Variance llnd modification application
I..u. lID be k1bbiecl (I~b.. in deQil):
IlL crrr AGENCIE5/INDMDUALS TO'''. LOI!IIUED:
A) F..I l'Ielll. ., 1ndiwid...'ITItI.. .) Ralall.....ip
Jorge Gomez, Director None
Armando Valdes None
Tom Mooney . None
William Carey ~one
SENT BY: .BERCOW & RADELL, PA;
...~ "I.
3053778222;
JUL-31-02 .2:31PM;
PAGE 8/8
lV, DISCl.05URE OF 'R:RMS AND _MOUNTS OF LaBansr COMPENSATION (DlSQ.OSE WHmtfR. HOURLY,
FLAT~TEOR OTHER):
A} LOBBTJST DISCLQSURE:
Hourly
($400.00)
II} PRlNaPAL'S DISCLOSURE (OF L08BY15T CXlMP'fNSAnoN):
Hourly ($400.00)
v. SIGNAnJRE.UNDD o"ntl
oM CCTOBER 1'" Of EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THIS CITY CLERK A SIGN!!!)
STATE...t!l'O' UNDER OATH,. UmNG LOBBYING D:PENDITUA.ES IN THE CITY OF MIAMI BEACH FOA.
THE PRECIPINGi CALENDAR YEAR.
I do solemnly swear that an of the foregoing facts are true IInd correa and that I have read or am
familiar with the pruvisions contained in Sec:tlon 2......82 af the Miami Beach City Code il5 amended, and all
reporting n!ICIL/in:menls.
f
,
Slgnat\Jre at LDbb1lst:
~
Slgnatur~ of Principal/dlent:
VL
'" Produced 10
Form of Identification
14 Personally Known
VII. SIGN"TURE AND STAMP. OF NOTARY OR. DB'UTY CU:A.I(:
State of Florida, County of Miarni.Dade
Sworn to and subsaibed befo~ me
This day of , 2002.
~
ublic Notary - State of Florida
L. JUDITH 6ASlCdl
.... P'I!II!.!r ~ tJ FkvldIl
Print. ~I ~,.~~. _IV Public
QIM.No.CC904314
.'POR CLeRK'S USE ONLY
ReglsnuDn; 1\] ACCEPTED [] REJECTED
DATE:
8 -1.-()t:
If rejeCted. 5la~ n:ilSDl1:
_'on "" pOd, t\ ~L l; ""'" HCR' ~'l->? ~ .
DATA ENTRY' DATE: tf / ,/ . 2002 eNTe~o BY /" j.:J.
1 ,
I first RevIsI"". Q5/17/0Z
~'~!~y: ~~cow & Radellj
:.;.r~;' .
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305 377 6226j
Jul-29-02 10:12AMj
Page 3/5
lV. DISCLOSURI! OF TERMS ~ND AMOUN15 OF LOII8YIST COMPEN~TlON lDI5Q.OSe WtI~ HOURL Y,
Fl.A T RA T! OR OTHER):
A) lOBBYlST DlSClOSURF.=
Hourly ($400.00)
II) PRINCJpAL'S Dlsa..clSURe (OFlOBBYISTCOMpeNSATION):_. . Hour ly ($400.00)
V. SJ6H4TUIU! UNDER OATH:
ON Q(;TOBER 1'" Of rACH YEAR" EACH LOBBYIST' SHALL SlIBMIT TO THE c:ny. CLERK A SIGNED
STATeMENT UNDER OATH, U5nHG LOBBYING EXPENDITURES IN THe CITY OF MIAMI BEAcli FOR
THE PIU!C:l:DING ~LENDAR YEAR.
VL
I do solemnly swear that all of the fo
fa mlliar with the provisions contain
reporting requiremenl3.
F1CATEON:
.w5Z:r'f!,/~37-c{IL{( ~ve)5{'-c..}
Form of Identification '
Co Personally Known
VII. SlGN~nJRf AND STAMP Uf NOT~R"f OR DfPllTY CLERK:
State of Florida, County of Miami-Dade
Swom to and SUbscribed~1 me
This "7' day of ,2002.
(I. ~~~~
. .JlIpbIs JIm. 3J. 21106
AImIIIflIlIIl7 Print, stamp or type name of Notary Public
.w.. t~61
I-R
,
. '/'OR CLERK'S USE ONLY
Re(jistralion:
] ACCEPTED [J REJECTED
DATE:
If rejected, Slate n:asOfl:
Reg/Stratioo fee paid: [ l'res [ ] No
[ 1 Cash [ 1 Olecl< MeR #
OAf A ENTRY DATE: .2002 ENTERED BY:
I
L..
, FIrst RlIVilion - 05/17/02