Robert Lewis/Publix Super Markets, Inc.~ M1A1~11BEA~N
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City of Miami Beach OfFce of the City Clerk -.e ~
1700 Convention Center Drive, Miami Beach, FL 33139 ~~-- ~
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LOBBYIST REGISTRATION FORM i" ' N ,--1
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Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passa l'defea~
an
adion
decision
recommendat~~ of tF
or decision of an
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City Manager or any city board or rnmmittee; or any action, decision or recommendation of any city personnel during ~e time ,,,~
period of the enare decision-making process on such action, dedsion or recommendation that foreseeably will be heard or FeYiewe~ ~
by the city commission, or a aty board or committee. The term specifically indudes the principal as well as any employee ~n~gag~D
in lobbying adivities. The term "Lobbyists" has specific exclusions. Please refer W Ordinance 2004-3435. r„ ~
Lewis Robert F.
NAME OF LOBBYIST: (Last) (First) (M.I)
Gray Robinson, P.A., 401 E. Las Olas Blvd., Suite 1850
Fnr~ T.aii~rrinlc FT. '~'~'~f11
BUSINE55 NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: MAIL:
I. LOBBYIST RETAINED BY:
Publix Super Markets, Inc.
NAME OF PRINCIPAUCLIENT:
Publix Super Market
3300 Publix Corporation Parkway, Lakeland, Florida 33811
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code)
u,(~ tiaA ~dn~
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trost [Section 2-482 (c)]
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFIQARY:
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
*Please see attached.
II. SPECIFIC LOBBY ISSUE:
Representation in a variance hearing for a distance requirement
fnr ~'1PPY an~ cui r~~a Sa~.QS for.-c~ff = rami cr~ ~nnci~m~j,r.L~Lln1T.
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title ~ B) Any Finanaal, Familial or Professlonal Relationship
Board of Ad-justment
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHE'THER HOURLY,
FLAT RATE OR OTHERr
VI. LOBBYIST IDENTIFiCATION:
^ Produced ID
~ o Form of Identification
~ S ~ ~ ~," Personally known (Lobbyist)
~~
~ VII. SIGNATURE AND STAMP OF NOTARY:
~
~
~~~ QoW~
State of Florida, Counry ofaM'~am'rB~d~
~~ Sworn to nd subscribed before me
~
~ This ,s7r I
_day of Sun 2 . 20 0~
/ ~ ~ A
of f~Gblic Notary - State of Florida
t~ofi of Lobbyist's si9nature
PRINCIPAL IDENTiFICATION:
~oduced ID ~YC ~iv~s Lt cG/-se
Form of Identification
~ Personally known (Principal)
~w~'`~
State of Florida, County of M~ert~i-Bade
Sworn ar~d subscribed before me
This ~! _day of v c~re . 20 C~
Signatdre of P~iblic No r~'- State of Florida
Notarizafiee~ ef•.P ' rinal'c cinn~t~.re
A) LOBBYIST DISCLOSURE: (Required) hourly
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). At~p~ j(,arit
The following information must be answered:
1) Pursuant to Miami Beach City Code Sedion 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^ Yes ~rNo• Are vou lobbvina 4n a cresent or cendina bid for goods eauioment or services or on a
present or oend~na 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":
DYes ~ No: Are vou lobbvina on a oendina auulication for a Develoument Aareement with the Citv or
a°°I~cat~on for chanae of zonma ma~ designation or change to the Citv's Future Land Use
Mau?
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 ~r7 No: Are vou reuresentina a not-for-~rofit corooration or entitv without soecial com~ensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER isT OF EACH YEAR, EACH LOBBYIST SHALL MIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPEND RES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE E ING CALENDAR YEAR. A STATEMENT
SHALL BE FIIED EVEN IF THERE HAVE BEEN NO EX N URES OR COMPENSATION DURING THE
REPORTING PERIOD. ~ /
~iyna~ure or ~oooyisi
I do solemnly swear that all of e oregoing facts are true and correct and that I have read or am
familiar with the provisions con i 'n Section 2-482 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist: .~ ~ ~
Signature of Principal/Client:
~ - ---'- -- „"_'r_' ~ ~.~. ..~~...
R CLE E LY { .l
Annual Registration fee: ] Yes [ ] No unt Pai CR ate Paid V
Lobbyist Registration Form received and verified
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST f0 OS.doc . Revised 1/08/04
Ownership Interest in the Principal of Publix Super Markets, Inc.
Title/Position Name Stock %
President William E. Crenshaw 0.33
Vice Presidentl Charles H. Jenkins, Jr. 0.91
CEO
Seeretary John A. Attaway, Jr. 0.00
Treasurer David P. Phillips 0.43
Director(s) Howard M. Jenkins ' 3.76
Carol Jenkins Bamett 5.74
Stockholders Hoyt R. Bamett 0•72
Advisor to CEO Tina P. Johnson 0.03
Senior VP Robert S. Chazlton 0.00
Randall T, Jones 0.00
VP Real Estate John T. Frazier 0.01
Assistant Secretary Sharon A. Miller 0.02
Bar Manager Director of Tax & Treasury 0.00
(Fraternal Organizations of Kelly Underhill
National Scope)