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535 West Avenue, LLC e 0" , ;:J a:> ?' U'> ~ Cl cP "'" .. -n Lobbyist means all persons employed or retained, whether paid or not, by a prlndpal who seeks to encourage the pa~defEit or modification of any ordinance, resolution, action or decision of any commlsslonerj any action, decision, recommendatl~i Jre' City Manager or any city board or committee; or any action, decision or recommendation of any dty personnel deflned 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 Indudes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. MiMi 8CDd1 ""' """. City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM Dougherty Lucia A. NAME OF LOBBYIST: (last) (First) (M.I) 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: EMAlL: I. LOBBYIST RETAINED BY: 535 West Avenue, LLC NAME OF PRINOPAl/CUENT: 535 West Avenue, LLC BUSINESS NAME AND ADDRESS 1100 Biscayne Blvd, 7th Floor Miami (Number and Street) (City) FL (State) 33132 (Zip Code) 305-379-7246 TELEPHONE NUMBER: 305-579-9961 FAX NUMBER: (Opbonal) EMAIL: (Opbonal) Fill out this section If principal I.. Corporation, Partnership or Trust [Section 2-482 (ell . NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Bob De La Fuente . IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Ai & Boymelgreen & HNH Investments, LLC II. SPECIFIC LOBBY ISSUE: RelocationNacation Alley, DRB, BOA and Perm~ Issues lssue to be lobbied (Describe in detail): III. CITY AGENCIES/INOIVlDUALS TO BE LOBBIED: A) Full Name of IndlviduallTitle B) Any Financial, Familial or Professional Relationship Planning Department DRB. BOA & Zoning Department Mayor I City Commission I City Manager ~ rn () rn - .:::: rn o IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $465,00 HOURLY B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required), $465,00 HOURLY Yes No: Are YOU reDresentina a not-for"Drofit corDoration or entity without saecis. comDensation or reimbursement. Pursuant to Ordinance No. 2004-3435. 1) Pursuant to Ordinance No. 2003-3393 AmendinG Miami Beach City Code Chaoter 2. Article VII. Division S Thereof Entitled "Camoaian Rnance Reform" Via The Addition Of Code Section 2~88 Entitled "Prohibited Camoaie" Contributions Bv Lobbvists On Procurement Issues": Yes No: Are YOU lobbyina on a Dresent or aendina bid for Goods. eauiDment or services. or on a Dresent or aendina award for Goods. eauiDment or service? 2) Pursuant to Ordinance No, 2003-3395 Amendino Miami Beach City Code Chaoter 2. Article VII Division S thereof Entitled "Camoaion Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited Camoaian Contributions BY Lobbvists On Real Estate DevelQoment Issues": Yes No: Are YOU lobbvinG on a endinG 8DDlication for a DeveloDment Aareement with the City or 8DDlication for chanGe of zonina maD desiGnation or chanGe to the City's Future Land Use MaD? V. SIGNATURE UNDER OATH: ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING LENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURE COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist VI. LOBBYIST IDENTIFICATION: e and correct and that I have read or am e Miami Beach City Code and all reporting I do solemnly swear that all of the foregoing facts are familiar with the provisions contained in Section 2-482 f requirements. Signature of Lobbyist: Signature of Principal/Client: D Produced ID D rod ced 10 Form of Identification Form of Identification ~rsonally known (Principal) 1'J-. Personally known (lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed before me This -z....., day of 20Q~ State of Florida, County of Miami-Dade swo~ aod subscriPed ore me ~.l This ~da f~(A 2 v'f c.~ o~u.."" tate of Aorida Notarization of Lobjjyist's signature Signature 0 Public Notaoy - State of FI rida Notarization of Pri n IALNOTARYSiAL o....t- <", PATRICIA A KUNDE ~ ~ COMMISSION NUMBER c.!\ <" 00065451 "1:- ~ MY COMMISSION EXPIRES OF F\..O OCT. 16,2005 FOR CL Annual Registration fee: [ ] Yes [' ] No Amou t Lobbylst Registration Form received and verified by: Revised 02/10/04 F: CLER 'S USE ONLY . ~ c7 ~ ' MCR # 27,)7.~~Datepald q -^ r uY