Andrew Frey~~ ~~
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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.
Frey Andrew W.
NAME OF LOBBYIST: (Last) (First) (M.I)
Akerman Senterfitt 1 S.E. 3rd Ave. Miami FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-374-5600 305-374-5095 andrew.frey@akderman
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
420 Lincoln Road Development,LLC
NAME OF PRINCIPAUCLIENT:
420LR Development, LLC 420 Lincoln Road Miami Beach FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
~~5-531-5220
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482
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:
n.SPECIFIC LOBBY ISSUE:
420 Lincoln Road development approvals and related matters
Issue to be lobbied (Describe in detail):
ul. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City code section z-48z(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) Any Financial, Familial or Professional Relationship
Planning Board, BOA, DRB, Land Use Committee NONE
HPB NONE
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
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B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). SBnle
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 lobbvinq on a present or pendina bid for Goods eauipment or services: or on a
present or pendina 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 ®No: Are you lobbvinq on a pendina application for a Development Agreement with the City or
application for change of zoning map designation or change 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 snot-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 representing anot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
I do solemnly swear that all of the foregoing
provisions contained in Section -482 of the ~
Signature of Lobbyist: ~
Signature of Principal/Client: _
VI. LOBBYIST IDENTIFIC
^ Produced ID
Form of Identification
are true ~A~ correct and
3eachldRv Code and all i
® Personally known (Lobbyist)
VII. SIGNATURE AND STAMP`Q,~t~A~ARY:
State of Florida, County of Mia,~'~``` L' BFq''~~~i~i
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Sv~orn to,~n`d subscribe bef ~ @•'~S~aA%E~'•~.~
~/~ ~~ ~~& CPS ~ ••
~gnature of Public Notary ~ ~ . f~171 _~.' ~. ,
Notarization of Lobbvist's ~~A~ah:scs~:•••-~\;
i i. c~' _O
"' 155 D BY
Annual Registration fee: [ )Yes [ IIIK1 unt Paid $
Lobbyist Registration Form received and verified by:
F:~CLE1t~FiATL~FOrms~i.®bbyl5t t2tgistratiOrt Ftsrm.dt3C
~ave read or am familiar with the
ing requirements.
PRINCIPAL IDENTIFICATION:
~ Produced ID
Form of Identification
® Personally known (Principal)
7~ .vC~
me
_, 2008
ic.Not 6tate of Florida
~ ' i s signature
# _ Date Paid
Revised 03/27/2008
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Ciiy of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk@miamibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: Andrew W.
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.
Sig
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Date:
F:ICLFtit_t3Y1ST1L.obyist egi~l:ratirsn Form 32708.doc