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535 West Avenue, LLC , Miami 8~ W .Il103 m City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 ~ -f C) r. '" ;;c co Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passa~ defB or modification of any ordinance, resolution, action or dedslon of any commissioner; any action, dedslon, recommendatl6" of I:lIe Oty Manager or any city board or committee; or any action, decision or recommendation of any city personnel deflQ In M manner In this section, during the time period of the entire decision-making process on such action, decision or recom~datlOii that foreseeably will be heard or reviewed by the city commission, or a city board or committee. The term spedfically l"P9des..ft prlndpal as well as any employee engaged in lobbying activities. The term "Lobbyists- has specific exclusions. PI~ r4iler to Ordinance 2004-3435. LOBBYIST REGISTRATION FORM Gonzalez Alfredo J. NAME OF LOBBYIST: (Last) (First) (M.!) 1221 Brickell Avenue Miami Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip COde) 305-579-0588 305-961-5588 gonzalezaj@gtlaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: 535 West Avenue, LLC NAME OF PRlNCIPAl/CUENT: 535 West Avenue, LLC 1100 Biscayne Blvd. 7th Floor Miami BUSINESS NAME AND ADDRESS (Number and Street) (City) FL (State) 33132 (ZIp Code) 305-379-7246 TELEPHONE NUMBER: 305-579-9961 FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section If principal Is a Corporation, Partnership or Trust [Section 2-482 (e)l . 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. 5PECIFIC LOBBY ISSUE: RelocationNacation of Alley, ORB, BOA And Pennit 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 Planning Department ORB, BOA & Zoning Department Mayor I City Commission I City Manager o .s=- U') r-., " :::u r'/1 (") ;-fl < rn o IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLA T RA TE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $250,00 HOURLY B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required), $250.00 HOURLY Yes No: Are YOU reDresentina a not-for-Drorlt corDoration or entitY without sDeClal camDen_tiC" or reimbursement. Pursuant to Ordinance No. 2004-3435. 1) Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach Citv Code Chaeter 2. Article VII. Division 5 Thereof Entitled "Camoaie" Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited Camoaie" Contributions BY Lobbvists On Procurement Issues": Yes No: Are YOU lobbvina on a Dresent or Dendina bid for Goods, eouiDment or services. or on a Dresent or Dendina award for Doods. eauiDment or service? 2) Pursuant to Ordinance No, 2003-3395 Amendino Miami Beach atv Code Chaeter 2. Article VII Division 5 thereof Entitled "Cameaion Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited Camoaian Contributions BY Lobbvists On Real Estate Develooment Issues": Yes No: Are you lobbvinG on a endinG aDDlication for a DeveloDment AGreement with the City or aDDlication 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 PRECED NG CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPEND 0 PENSATION DURING THE REPORTING PERIOD. I do solemnly swear that all of the foregoing facts are true an correct and that I have read or am familiar with the provisions contai ed in ion -4B2 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: o Produced ID o Produced ID Form of Identification Form of identification ~rsonally known (Prindpal) ~ Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed before me This S' ? 2()'O '-\ . Signature of Public Notary - tate of Florida Notarization of Principal's signature ~ \l'l' P OFFlCIALNOTARY SEAL 0'''" U6I(/. PATRICIA A KUNDE '< ~ ': COMMISSION NUMBER ~ - <{ 00065451 71- q.~ MY COMMISSION EXPIRES ~_'?Fl~~ ~_ ocr. 16.2005 /' FOR CLE Annual RegIstratIon fee: [ \.J.oY€s [ ] No Amoun P Lobbyist Registration Form received and verified by: RevIsed 02/10/04 F: CL \A ARIA-M\LOBBY1Sl\LOBBYIST FORM 04 Cj-g..-c:,'f