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Integrated Equities, Inc. Mim1i 9ciXh IiIIlI! 'IUf 2liUJ lD - - 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 defined In any manner in this section, 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 "LobbyistsW has specific exclusions. Please refer to Ordinance 2004-3435. Dougherty Lucia A. NAME OF LOBBYIST: (Last) (First) (M.!) 1221 Brickell Avenue Miami Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-579-0603 305-961-5603 doughertyl@gtlaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: INTEGRATED EQUITIES. INC. NAME OF PRINCIPAl./CUENT: 215 E. DILlDO DR. BUSINESS NAME AND ADDRESS MIAMI BEACH (Number and Street) (City) FLORIDA (State) 33139 (Zip Code) TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal Is a Corporation, Partnership or Trust [Section 2-482 (c)] NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: MITICHELL RUBINSON IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: MITICHELL AND EDDA RUBINSON II. SPECIFIC LOBBY ISSUE: 2228 PARK AVENUE BUILDING & ZONING ISSUES Issue to be lobbied (Describe In detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or professional Relationship HISTORIC PRESERVATION BOARD BOARD OF ADJUSTMENT PLANNING AND ZONING DEPARTMENT 06/30/04 12:48 GREENBERG TRAURIG ~ 3058683925 NO. 445 [;103 IV. DISCLOSUIU OF RAMS ~ND AMOUNTS OF LOIIYJST COM'ENSATlON CD(SC~OS' WHITHIIl HDWU Y, FLA T RA TE OR OTHER): $465.00 Hourly A) LOBBYIST DISCl.05UItE: (lI8qulred) $465.00 Hourly II} PRlIIOl'/l.l'S DISCLOSURE (OF LOIlIlYIST COM~EN5AnON): (Required). ~ .:~: No_MInD a not-far-profit COl'llOr.t:llln or entity without slM!C:lal comlMlnutlan ar i II Pl.lr'iLlllnt to Ordinance No. 2004-3435. 1) ~ 2) ~ v. ~l'5uant to Ordltl8nca No. 2003-3393 Amendlna Mlaml1lellch Cltv end.. Chaetar 2. ;Artide VII. DMslon S ..reM Entitled "Camcalan Rnan.!' R~nn' VIa nil AdtiitlQn Of rnd.. 5f!ction 2-488 Entitled "Prahlblred a.mpaign.tP'ltrlbutloni e. Labbvists On Procurement I"~UAS": ~~~~;;~~~.:;:~:I~~::rb::~Dds. equloment or 5~I~e5. M an a D~nt pursuant to ardin.nm No 2003.30305 Amendina Miami Beach atv Code Chaoter 2. Article vn Diviilon 5 ttlereof Entlll8d "Camcal9n FlnallCll Reform" Via ih, AIldltion Of Code SectIon 2-490 I!ntltled nProhibib!d Camca~n Conbibutlons ay Illb~ nn Real f!lt~tp. Dl!\I@lo.prT18nt ls~ues": :: ~~bvina an a Dendi_ allDlit:lltlon for II DeVl!llo_nt A9r.ment with the CitY IIlI' UIIlcIItlon for chanae of Dnlna maD dMianlltion or chana. to the ClfY's Future Land Use Mllo~ SIGNATURE UNDEIt OATH: ON OCTOBER ,Sf OF EACH YEAR, EACH LOBan5f SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, U5T1NG LOBBYING EXPEND RES, AS WELL AS C:OMPENMT10N RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE P D N YEAR. A SfATEMENT SHALL BE fI~D EVEN IF THERE HAVE BEEN NO EXPEN PENIAT10N DURI 1111 REPORTING PEIUOD. I do solemnly swear that all d the foregoing facts are true and correct and that I have read ex am "loll'.. ... 'M ,-00'" """""" '" 0' ..... - CIty ~ ., ..- requirements. , Signature of Lobbyist: Signature of PrlnclpaVOient: VI. LOIIYIST IDENTIFlCATlONI ~ _ o PrcduQ!CI ID Form of IderlllflC8tlon pi Personaltt known (Lobbyllit) VII. SlGNAnJRI! AND STAMP 01' NOTARY: PRINCIPAl. IDENTIFICATION: ~ o Produced ID FDrm of Idemimtlon ~nallV k~own (Principal) State of Florida, Olunty d MiamI-Dade Sworn and 5\lbscribed before me u. ThIs :1e..-day of ~ - \ " ~C8lrieSommer . ~i My CommIIIIon 00221814 ~..~ ExpinIIJune11.2007 ~~;)7a~I;V OatePald 7