Lucia A. Dougherty~~ ~~ p ~~ r~ ~ ~~o,a-~o
m MI%,;`,%~JBEACH
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
spec~cally inGudes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please
refer to Ordinance 2004-3436.
DOUGHERTY LUCIA A•
NAME OF LOBBYIST: (Last) (First) (M.I)
Greenberg Traurig P A. 1221 Brickell Ave. Miami FLORIDA 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305 579-0603 305-961-5603 doughertyl@gtlaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
TODD GLASER/GREENBERG TRUST
NAME OF PRINCIPAUCLIENT:
5790 North Bay Rd. Miami Beach FLORIDA 33140
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
/-sen~ nno ne~~ (3051 538-430 -
1 / V V I LVV L I L'7
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:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY ISSUE:
Variances for Property located at 5790 North Bay Road, Miami Beach
Issue to be lobbied (Describe in detail):
ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code section 2-as2(g)
include a statement of the extent of any business, financial, familial, professional or other relationship, giving raise to an
appearance of an impropriety, with any City personnel sought to be lobbied; further, pursuant to City Code Section 2-
482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding the
commencement of service of City personnel to be lobbied.)
A Full Name of Individual Title B) An Financial, Familial or Professional Relationship
Mayor & Commissioners, City Attorney & Manager N/A
Planning Board, Zoning Board of Adjustment N/A c7 0
Design Review Board,Historic Preservation Board -~. ~
N/A ~. ~a.
r•,
,;
"`1
_,_
t~
-~
3
N
.T' ~~
•..~ ~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
' RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $645.00
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION)_645.00
(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 goods. equipment or services, or on a
present or pending award for goods. equipment 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_~~ou lobbying on a pending application for a Development Agreement with the City or
application for chance of zoning map designation or chance to the City'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 snot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
I Produced ID Produced ID
. ~,
>~;:,. "~ ~ Form of Identification _
Form of Identification
~~„ `~
~~•~''' X personally known (Lobbyist) Personally known (Principal)
X ~~
VII. SIGNATURE AND STAMP OF NOTARY:
~ 'a
~ State Florida, County of Miami-Dade State of Florida, County of Miami-Dade
:~
~t Sw n o nd subscrib d be me
2
T ' da n Sworn and subscribed before me
2008
This day of
, ,
.~
:? i ure of ublic Notary -State of Florida Signature of Public Notary -State of Florida
+~ N rization of Lobbyist's si ature Notarization of Principal's signature
TO BE COMPLETED BY CITY ERK'S STAFF ON Y
Annual Reglstratlon fee: J Yes [ ] No Amount Pald S MCR # Date Pald
Lobbyist Reglstratlon Fo received and verified by: _
F:1~LER~LflBBYIST1Lobbyist Registration Form 327Q8.doc Revised 03 27/2Q08
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 Section 2-482 of the Miami Beach City Code~nd all reporting requirements.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER}:
A) LOBBYIST DISCLOSURE: (Required) $645.00
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATIONL645.00
(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":
~~_ `~~i
,Ti
~'
,~ ~ ~;.
Y
~~~-~
~``
,~ .~
i
~~
~~
,~s
s;
Yes X No' Are you lobbvina on a present or pending bid for goods. equipment or services, or on a
present or pending award for goods, equipment 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 lobbytna on a pending application for a Development Agreement with the City or
application for chance of zoning map designation or chance to the Citv'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 281 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 x No: Are you representing snot-for-profit corooration or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist: _
Signature of Principal/Client:
VI. LOBBYIST IDENTIFI ATI PRINCIPAL IDENTIFICATION:
Produced ID _ Produced ID
Form of Identification Form of Identification
X Personall
known (Lobb
ist)
ersonall
known (Princi
al) ~:
=
<
y
y y
p .g- ~
VII. SIGNATURE AND STAMP OF NOTARY: o ~
°
m X C7
State Florida, County of Miami-Dade State of Florida, County of Miami-Dade ~ ~
Sw o nd subscri be me Swo subscri d before me
~
~9 Z ~ ~ c
T da n 2 V1
This
, 200 ~
€~ ~ ~
°
i ure of ublic Notary -State of Florida
Signatu of Public Notary -State of Florida a~
"o
g ~ z
ization of Lobbyist's signature Notarization of Principal's signature ~ o w
~
?
TO BE COMPLETED BY CITY C RK'S STAFF ONLY ff
1
Annual Registration fee: [ ]Yes [ ] No Amount Paid S ~ MCR # ~ Date Paid
Lobbyist Registration Form received and verified by:
f:1CLERILOBBYI5T1Lobbvist Regisdatwn form 327r~.doc Revised 03/27/2008
I do solemnly swear that all of the foregoing facts are t and correct and that 1 have read or am familiar with the
provisions contained in Section 2-482 of the Miami~Beac~ity Code end all reporting requirements.
!i s ~ t ~
.~ ~ ~ _
i } .~
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME: LUCIA A. DOUGHERTY
I understand that no later than October 1st of each year, 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
Failure 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 Office of lobbyist withdrawal in writing.
January 16, 2009
Signature: Date:
C ityC Jerk@m is m i beachfl.gov
F:ICLER1~pBBYISTILobbyist Registration Form 32708.doc