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Robert Fine/Kenneth Faltischek 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, 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 city commission, or a city board or committee. The term specifically includes the principal as well as any employee engaged /n lobbying activities. The term 'Lobbyists' has specific exclusions, Please refer to Ordinance 2004-3435, Fine Robert S. NAME OF LOBBYIST: (Last) (First) (M.I) Greenberg Traurig 1221 Brickell Avenue, Miami FL 3313 l BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-579-0826 305-961-5826 finer~gtlaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Kenneth D. Faltischek, Just Around the Comer, LLC, NAME OF PRINCIPAL/CLIENT: 4B's Realty Collins Ave, LLC, POP Development, LLC 205-237 20th Street; 2000-2038 Collins Avenue; 220 21st Street, Miami Beach, Florida BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Tip Code) TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a CorporaUon, Partnership or Trust [Section 2-482 (c)] · NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Kenneth D. Faltischek · IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Just Around the Comer, LLC, 4B's Realty Collins Ave, LLC, POP Development, LLC 1/. SPECIFIC LOBBY ISSUE: Extension of Construction Deadline Board of Adjustment Order Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title City Manager / Commission Building Department Planning Department B) Any Financial, Familial or Professional Relationship 1V. DZSCLOSURE OF TERMS AND AMOUNTS OF LOBBY/ST COMPENSA1/ON (DZSCLOSE WHETHER HOUR£ Y~ FLAT RATE OR OTHER):. A) LOBBYIST DISCLOSURE: (Required) 430.00 Ho~ly B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $450.00 Hourly The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": [] Yes ~ No: Are you Iobbyinq on a present or Dendina bid for qoods, equipment or services, or on a present or Dendina award for aoods, eaui=ment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": []Yes A No: Are you Iobbvina on a nendinq application for a Development Aqreement with the City or aDulication for chanqe of zoninq map desiqnation or chan,q~ to the City's Future Land Use 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-profit 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 reDresentinq a not-for-Drofit corDoration or entity without sDecial comDensetion __ or reimbursement.. V. SZGNATURE UNDER OATH: ON OCTOBER Is'r OF EACH YEAR, EACH LOBBYZST SHALL SUBbIl'T TO THE CTFY CLERK A SZGNED STATEMENT UNDER OATH, LTSTTNG LOBBYZNG EXPENDTrURES, AS WELL AS COMPENSATZON RECEI'VED, TN THE CI'TY OF Mi'AH1' BEACH FOR THE PRECEDI'NG CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN ZF THERE HAVE BEEN NO EXPENDI'I'URES orq~coMPENSATZON DURING THE REPORTTNG PER/OD. 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 ' ' ' Beach City Code and all reporting requirements. Signature of Lobbyist: -d Signature of Principal/Client: VZ, LOBBYZST 'rDENTZFTCATTON: pRTNCZPAL ZDENTZFTCATZON: Produced ID Form of Identification ~ Personally known (Lobbyist) V/I:. SZGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed before me !r~ n-'~Public NoJ~ S~te of Florida N ora rizatio~l~oi~ ~~'1 ~J~~.._. Produced ID Form of Identification X Personally known (Principal) State offside, County of Miam~N~Je Sworn and subscribed before me This~ day of ~"C,~/'V~,-~ 20__~, Signature o? P~c NO~ - ~ of ~ No~rization of Principal's signature Yes FOR CLER~'SUSE. ONLY Annual Registration fee: [ [ ] No Amount Paid ,~::).c::)(.~ MCR #~ ~~ Date Paid Lobbyist Registration Form received and Verified by: I,'"'~ F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 0~uJ~ '-'-"- Revised 12/08/04'