Lucia A. Dougherty/Double ParkM1Trxni Br°Gri
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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.
DOUGHERTY LUCIA A•
NAME OF LOBBYIST: (Last) (First) (M.I)
Greenberg Traurig 1221 Brickell Avenue, Miami, FL 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:
I. LOBBYIST RETAINED BY:
1]ouble Park
NAME OF PRINCIPAL/CLIENT:
1717 N. Bayshore Drive, Suite 201, Miami, FL 33132
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp woe)
(305) 932-8600 x. 205
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:
Mitchell Liss and Gino Falsetto
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Revocation or Suspension of Business License and Certificate of Use for Parking Valet Use
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/T"itle B) Any Financial, Familial or Professional Relationship
Special Master, City of Miami Beach
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERJ:
A) LOBBYIST DISCLOSURE: (Required) $645.00 per hOUr
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $645.00 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":
ioresent or Dendina award for goods eauioment or service
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Este Development Issues":
a lication for change of zoning may designation or chance to the Citv's Future Land Use
.Ma°?
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..
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ 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 CO~~NSATION DURING THE
REPORTING PERIOD. ,~~~ %
Signature of Lobbyist
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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 o the Miami Beach City Code and all reporting
requirements. ~
Signature of Lobbyist: I / Y ~
Signature of Principal/Client: '"-"~_ l~.~ci„~\1 ~-5a.~ l'.~s~
VI. LOBBYIST IDENTIFICATION:
Produced ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
~~~ State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ~_day of 'So 20~°~
- State of Florida
Notarization of Lobb st's signature
PRINCIPAL IDENTIFICATION:
Produced ID FL.-'pr, ~=~ c. L_Z.oO- ~ 5Z)
Form of Identification
^'Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This 1S day of "~~~ _ 20 a~
Sig a of Florida
Notarization of Princip signature
FOR CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc Ravised 12/08/04