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Carlos & Yasmin GarciaCity of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 Emaih cityclerk@ci.miami-beach.fl.us LOBBYIST REGISTRATION FORM (City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481) Check Box if an Amendment DOUGHERTY LUCIA A. NAME OF LOBBYIST: (Last) (First) (M.I) DATE QUALIFI ED AS LOBBYIST Greenber~ Trauri~l, P.A. 1221 Brickell Avenue Miami Florida 33131 BUSINESS ADDRESS: (Number and Street) (City) (State) (Zip Code) 305-579-0603 305-961-5603 dou~hert;/l@~tlaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Carlos & Yasmin Garcia NAME OF PRINCIPAL/CLIENT: 5860 Pine Tree Drive, Miami Beach, Florida BUSINESS ADDRESS: (Number and Street) (City) (State) (Zip Code) TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) 305-970-7494 Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] · NAME OF CHI EF OFFICER, PARTNER, OR BENEFICIARY: · LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Variance for 5860 Pine Tree Drive Issue to be lobbied (Describe in detail): II I. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/rifle B) Relationship SEE ATTACHED · 'FLAT RATE OR OTHER): $450.00 , A) LOBBYIST DISCLOSURE: B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): $450.00 1) Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach City Code Chaoter 2. Article VII. Division 5 Thereof Entitled "Campaign Finance Reform" Via The Addition Of (;ode Section 2-488 Entitled "Prohibited Campaiqn (;0ntributions By Lobbyists On Procurement Issues": 2) Are you Iobbyinq on a Dresent or Dendino bid for ooods, eaui~nt or services, or on a Dresent or pendinc] award for goods, eouiDment or service? Yes /~ Pursuant to Ordinance No. 2003-339S Amendino Miami Beach City Code Chaoter 2. Article VII Division 5 thereof Entitled "Campaign Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited Campaiqn Contributions By Lobbyists On Real Estate DeveloDment Issues": Are you I~bbyina on a Dendina application for a DeveloDment Aareement with the City or applicatJ~ for chano~e of zonina maD desianation or chanqe to the City's Future Land Use MaD? Yes ~ SIGNATURE UNDER OATH: ON OCTOBER IsT OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. 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 Section 2-482 of the Miami,J~ch City Code reporting requirements. Signature of Lobbyist: LUCIA A. DOUGHERTY Signature of Principal/Client: Carlos Garcia VI. LOBBYIST IDENTIFICATION: [] Produced ID Form of Identification as amended, and all VI I. State of Florida, County of MiamFDade Sworn to and subscribed before me This 15th day of January, 2004. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK: Print, stamp or type name of Notary Public FOR CLERK'S USE ONLY Registration: [ I"'~ACCEPTED [ ] REJECTED DATE: If rejected, state reason: Registration fee paid: [/Tj"~s [ ]~No [ ] Cash [~'~"'~ck M DATA ENTRY DATE: ~~L~, ~_ee~_ ENTERED BY: ~/ ~ 2nd Revision 3/18/O3 · ):LAT RATE OR OTHER): $450.00 ~ A) LOBBYIST DISCLOSURE: B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): $450.00 1) Pursuant to Ordinance No. 2003-3393 Amending Miami Beach City Code ChaDter 2. Article VII, Division 5 Thereof Entitled "Campaign Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited Camoaian Contributions Bv Lobbyists On Procurement Issues": 2) Are you Iobbvina on a present or oendina bid for aoods, ead~htent or or oendina award for ~aoods. eauipment or service? Yes \~No) services, or on a present v Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5 thereof Entitled "Camoaiqn Finance Reform", via The Addition Of Code Section 2-490 Entitled "Prohibited CamDaion Contributions By Lobbyists On Real Estate Development Issues": Are you Iobbvina on a oendina aoolication for a Develooment Aareement with the City or aoolicat~an for chanae of zoning map designation or chancle to the City's Future Land Use Map? Yes \Na~ V. SIGNATURE UNDER OATH: ON OCTOBER Is? OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. I do solemnly swear that ail of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code as amended, and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: Car~p.~ G~-rcia VI. LOBBYIST IDENTIFICATION: [] Produced ID Form of Identification Yas~r{ Garcia / Personally Known VI I. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK: State of Florida, County of Miami-Dade Sworn to and subscribed before me This 15th day of January, 2004. "'~ ' ~. M sANCHE Sig~. ~u~.lSl~b~ic Notary -/State of Florida Print, stamp or type name of Notary Public Registration: [ ~.~CEPTE D If rejected, state reason: Registration fee paid: [ ] Yes [ ] No FOR CLERK'S USE ONLY [ ] REJECTED DATE: [ ]Cash [ ]Check MCR Cf DATA ENTRY DATE: 2003 ENTERED BY: 2nd Revision 3/18/03 F :\CLE R\HATL\Lobb¥ists\registrationaO3,doc