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Clifford Schulman/O. Feldenkres 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 dty board or committee; or any action, derision or recommendation of any city personnel dudng the time period of the entire decision-making process on such action, decision or recommendation that foreseeably will be heard or reviewed by the dty commission, or a city board or committee. The term specifically includes the pdndpal as well as any employee engaged /n lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. Schulman Clifford A. NAME OF LOBBYIST: (Last) (First) (M.I) Greenberg Traurig 1221 Brickell Avenue, Miami FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-579-0613 305-961-5613 I I Illl II TELEPHONE NUMBER: FAX NUMBER: I. LOBBY/ST RET/i/NED BY: OScar Feldenkreis NAME OF PRINCIPAL/Cl TENT: Supreme International 3000 N.W. 107th Avenue Miami, Florida BUSINESS NAME AND ADDRESS (Number and Street) (City) (state) (305) 418-1310 (305) 470-7206 ~ 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: Oscar Feldenkreis · IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: SPECIFIC LOBBY ISSUE: Issue to be lobbied CDescribe in detail): CITY AGENCIES/INDZV~DUA~ TO BE LOBBIED: A) Full Name of Individual/Title Building Department Planning Department City Manager / Commission B) Any Financial, Familial or Professional Relationship XV. FL4 T R4 TE OR OTHER): A). LOBBYIST DISCLOSURE: (Required) $535.00 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $535.00 FJ[our]¥ The following information must be answered: DZSCLOSURE OF TERMS AND AMOUNTS OF LOBBY[ST COI~IPENSAT/ON (D/SCLOSE WHETHER HOURI Y~ 1) On Procurement Issues": Yes ~, NO: Are you iobb¥in~ ~n ~ ~r~.t ~nt or ~ndina award for a~s. ~uioment or ~i~? 2) Pumuant to Miami Beach Ci~ ~de 2~90 Entl~ 'Prohibit~ ~m~ign ~ntributions By Lobbyi~ R~ ~te Development ~sues": Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions '"~YLo~s DYes ~ No: Are YOU 10bbyin= on a m~ndin.q aoolication for a Develooment A=reement with the City or · ' a~olication for chan~e of zonin,q map desi,qnat;ion or ~hanae to the City's Future Land Un Hap? 3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of "lobbyist" as set forth in Section 2-481 above) who only appears as a representative of a not-for-prof'F~ corporation or entity without special compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any item, shall register with the clerk as required by this section but, shall not be required to pay any registration fees.. [] Yes ~,No: Are you reDresentina a not-for-orofit cor=oration or entity_ without $1~e¢ial coml~n~tion or reimbursement.. V. SZGNATURE UNDER OATH: ON OCTOBER 1sT OF EACH YEAR, EACH LOBBY[ST SHALL SUBMZT TO THE CITY CLERK A SZGNED STATEMENT UNDER OATH~ L/STZNG LOBBY/NG EXPEND!TURES~ AS WELL AS COMPENSA1/ON RECEZVED, ZN THE CTrY OF M:[AI4! BEACH FOR THE PRECEDinG CALEJ~DAR YEAR, A STATEMENT SHALL BE FILED EVEN !F THERE HAVE BEEN NO EXPENDTrI~RE)E; OR/CO~IPENSAT~N DURING THE V ~J-gna' e.0f Lobbyist ! do solemnly swear that all of the foregoing facts are true and correct and that ! have read or am familiar with the provisions contained in .~e~ction 2-482 of the Miami Beach City Code and all reporting requirements, f_ / / I --- . Signature of Lobbyist: ~..~ A, ~,,,i~j) . - ti- . S .natu, or 'rin i.aVC, nt: V'~.' LOBBY/ST ~DENT/FZCA1/ON: / ~ Pi~NCIPAL ZDENT/FZCAT[ON: ~ Produced ~D ~ .~ ~ Produced ZD Form of Identification '"' ~ ~'~ ~t-~n Personally known (Lobbyist) V/!. SZGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to~a~r, ubscribed before me This// 44 ' Sighature o'"'--f Public N'-otary- State ~of Florida Notarization of Lobbyist's signature '~ersonally known (Principal) J ' .~,~' ~. Notary Public State of Flonda i ,~ ~ ~, Leyla M Lucas 1 , .~ My Commms~on DD448676 State of Florida, County of MJamiJDalt~,~ ~ ' - ~ w h_xp~res 0912412009 Sworn and subscribed before,me[ - Signature"of P)~J~ Notary -' .~tate-of-Florida Notarizatio~f Principal's signature / FOR CLERICS USEONLY .-~ -, . ' Annual Registration fee: [ ~'~ Yes [ ] No AmognJi Pai~.~~[~__, MCR # /--~ / 0~,(o Date Paid Lobbyist Registration Form received and verified by: ~/J~'~-~/'J Z/_~_~ _ '. ~ F:\CLER\$ALL\MARIA-M\L0bbyist\LOBBYIST fOPJVl O~.d~c - - ' ~ ..... n-~ Revised 12108/04 J