Perry Adair/The Waverly at South Beach Condominium Association, Inc.
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MIAMI BEACH
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 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 "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
Adair
Perry
M.
NAME OF LOBBYIST: (Last) (First)
Becker & Poliakoff, P. A., 121 Alhambra Plaza, 10th Floor, Coral Gables, Florida
(M .I)
33134
BUSINESS NAME AND ADDRESS
(Numbu and Street)
(City)
(State)
(Zip Code)
305-260-1016
TELEPHONE NUMBER:
305- 442-2232
FAX NUMBER:
padair@2becker-poliakoff.com
EMAIL:
I. LOBBYIST RETAINED BY:
The Waverly at South Beach Condominium Association, Inc.
NAME OF PRINCIPAl/CLIENT:
The Waverly at South Beach Condominium Association, Inc., 1330 West Avenue, Miami Beach, Florida 33139
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BUSINESS NAME AND ADDRESS
305-674-5880
(Number and Street) (City)
(305) 674-5181
(State)
(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:
Derek Bond
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
Corporation is not for profit.
II. SPECIFIC LOBBY ISSUE:
Application to modify DRB Order.
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
Jorge Gomez from Planning & Zoning Dept. None.
Thomas Mooney None.
Design Review Board None.
--
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLA T RA TE OR OTHER):
Hourly, at $300.00 per hour.
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). Hourly at $300.00 per hour.
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":
D Yes ~ No: Are YOU lobbyina on a Dresent or Dendina bid for aoods. eauiDment or services. or on a
Dresent or Dendina award for aoods. eauiDment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes ./S] No: Are you lobbyina on a Dendina aDDlication for a DeyeloDment Aareement with the City or
aDDlication for chanae of zonina maD desianation or chanae to the City's Future Land Use
MaD?
l' Pursuant t-J r,11ami 8each City Code 2-484 (hj Ail)' person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) Wh0 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..
D Yes ~ No: Are YOU reDresentina a not-for-Drofit corDoration or entity without sDecial comDensation
or reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE P EDI CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EX NO T OR COMPENSATION DURING THE
~ro~~~~~ I
Signature of Lobbyist
I do solemnly swear that all of e foregoing facts are true and correct and that I have read or am
familiar with the provisions co tain d I ection 2-482 of the Miami Beach City Code and all reporting
requirements. (..
Signature of Lobbyist: ( -
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PR1NCIPAL IDEI\i rIFIC;'~T!ON: J
Signature of PrinCipal/Client;.Y-:::--.."::":
VI. LOBBVIST !DENTIF::~'
Produced ID
r Produced ID
Form of Identification
Form of Identification
'i Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This f-!tf: day 0 2Wt"....,
_"~~.Y.~IJ;/', 7\I1a M. Suarez
:""o.~~''''' Commission #DD321498
~~tate:~~l6fiiH[es: lun 29,2008
. :'~ . . . .clt:",- Bonded Thru
t s's'tfRa'tur~lantic Bonding Co., Inc.
State of Florida, County of Miami-Dade
swo~a~d subscribed bef
This day of C /). b
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Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
Signature of Pu :_ State of Florida
Notarization of Principal's signature
I ' FOR CLERK'S USE ONLY . <'J'
, Annual Registration fee: r ] Yes [ ] No Amount Paid '\c2!:> ~ MCR # .4 (Jf.{ -4 Date Paid ~
Lobbyist Registration Form received and verified by: 'ex ~5
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc' Revised 12/08/04