Gregory Kyle/Tom Bowman, The Fresh Market~? MIAMIBEACH
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.
Kyle Gregory S
NAME OF LOBBYIST: (Last) (First) (M.I)
Kimley-Horn and Associates, Inc. 5200 NW 33rd Avenue, Suite 109 Fort Lauderdale Florida 33309
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(954) 535-5105 (954) 739-2247 greg.kvle@kimlev-horn.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Tom Bowman, The Fresh Market
NAME OF PRINCIPAL/CLIENT:
628 Green Valley Road Suite 500 Greensboro NC 27408
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
336.272.1338 336.601.8965 tombowman@thefreshmarket.com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Redevelopment of NW West avenue & 18`" Street -Variance Approvals, and Conditional Use Permit
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 Dept., HPB, BOA, Planning Board, City Commission * None
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* Unless an issue is legislative in nature, HPB, BOA, Planning Board, and City Commission members are not lobbie d of a blic h~a~ir~g setting.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required) $ 224 73 oer hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $
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 X No• Are you lobbvina on a present or pending bid for aoods eauipment or services, or on a
present or pendina award for aoods eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
Yes X No• Are you lobbvina on a pendina application for a Development Agreement with the City or
application for change of zoning map designation or change to the Ciri's Future Land Use
Map?
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 anot-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 X No• Are you representing anot-for-profit corporation or entiri without special compensation
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 PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD. 1~ ~ w ., 1
~~ w
gnatur of Lobbyist
I do solemnly swear that all of the foregoing
familiar with the provisions contained in Secti
requirements. ,; ~ ~ J
Signature of Lo
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
Produced ID
._._..--- - ,.- dentification
_~..
Personally known (Lobbyist)
VII. f-AND STAMP OF NOTARY:
State of Florida, Coun of Miami-Dade
+E~'' ~' MY ~ I I ~ ~' 2~
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:~~ EXPIRES: APUnic~u ~anvrttera
- - e"of Florida
Notarization of Lobbyist's signature
facts are true and correct and that I have read or am
~ 2-482 of the Miami Beach City Code and all reporting
PRINCIPAL IDENTIFICATION:
f'aCJi~~QtU~injlt.~ Lam'
Produced ID ~ (~ y ~ ~
Form of Ider
Personally known (Principal)
~'Ob~'0jq~jsS~F9G
State of Florida, County of Miami-Dade ~Z,FS• oti c'~q~
Sworn and subscribed before me ~A ~ O
This~r~day of U vST' , 20~ ~"~,9~o~~Aiu
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V a
Signature o Public Notary -State of Florida ~
Notarization of Principal's signature
FOR CLERK'S USE ONLY ~
Annual Registration fee: [ ]Yes [ ] No Amount Paid~~ ~ MCR #~ ~ Date Paid
.,
Lobbyist Registration Form received and verified by: Entered By,
F:\CLER\$ALL\MARIA-M\LObbyist\LOBBYIST fORM OS.doc ~ Revised 12/08/04
~ ~~~~~~
Cify of Miomi Beae6, 1700 Convention Center Orev®, Miami Beach, Fbrida 33139, www.miamibeocfiN.gov
CRY CLERK Office CifyClerk~miamibeachfl.gov
Tel: 305.673.741 i , Fcx: 305.673.7254
LOBBYIST NAME: ~~--~~ /~ ~• ~Ur,'Q.,,,
I understand that no later than Ottcaber 1st of eachLyear, I must file the following
forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
1 ~ lobbyist Expenditure Form
2) Disclosure Form
Fai{ure to file these forms on a timely basis will result in my name being transmitted to the
Miami-Dade County Commission on Ethics and For code violation evaluation.
In addition, once an issue I have registered to lobby on has been resolved, i am required
to immediately notify the City Clerk's Clffice of lobbyist withdrawal in writing.
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Signature: Date:
Revised 02/0412008
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