Michael A. Gil/Walgreen Co.
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
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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 teen "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
Gil Michael A•
NAME OF LOBBYIST: (Last) (First) (M.1)
Bercow, Radell & Fernandez 200 S. Biscayne Blvd., Suite 850 Miami Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 377-8690 (305) 377-6222 MGiI@brzoninglaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Walgreen Co
NAME OF PRINCIPAL/CLIENT:
c/o Seth Gadinskv 1680 Michioan Avenue Suite 1001 Miami Beach Florida 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786) 276-2387
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: Publicly traded on the NYSE under the symbol WAG.
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: Publicly traded on the NYSE under the symbol WAG.
II. SPECIFIC LOBBY ISSUE:
Redevelopment of the property located at 1400 Collins Avenue (HPB/BOA)
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
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A) Full Name of Individual/Title* --1 O
B) Any Financial, Familial or Professional Rel~ions~p ,,-
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Planning and Zoning Department Staff, HPB, BOA, PB, City r--
None . - ~ ~,.
Commission -
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* Unless an issue is legislative in nature, HPB, BOA, Planning Board, and City Commission members are not lobbied outside of a public hearing setting. ~C~ i
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__ >' IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERx
P A) LOBBYIST DISCLOSURE: (Required) X250 00„per hour -
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $250 00 oer ho ~r -
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":
present or ~ending,award for goods eauiument 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 lobb In nnnlirntinn fnr a rlavoln nt gr~ment with the Clty Of
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~uolic~tion for chance of zoning mao des(gnation or change to the Citv's Future Land Use
Man?
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..
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 COMPENSATION DURING THE
REPORTING PERIOD. -
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Signature of Lobbyist
1 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 and all reporting
requirements. ~^ _ ~ ~
Signature of Lobbyist:
Signature of Principal/Client
VI. LOBBYIST IDENTiFICI
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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 `~~ d y of _ tJY~Q . 20_1
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Signature of,~'.yfblidNotary -State of Florida
Notarizatio of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
Produced ID u a ~
Form of Identification Q
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Personally known (Principal) QNJ~
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State of f~er~da, County e~P4+e~+-Bade 'v ~ ~'
Sworn and subscribed before me _
This ~$°t day of rn~ , 20~ ~ Q ~ ~
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Signature of P Notary -State of Florida z~
Notarization of Principal's signature
FOR CLERK'S US~ONLY
Annual Registration fee: [ ]Yes j~No Amount Paid o~~ [)~M~~CR # ~6 Da/t~e~Paid
Lobbyist Registration Form received and verified by: T~ ~~~~~~// Entered By: ~ `^r-
F:\CLER\;ALL\MARIA-M\LObbyist\LOBBYIST fORM OS.dac Revised 12/08/04
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City arf lVkiami Beach. ~i ~ Car~ventian enter Crive, ~,/:iam.i Beaci~, F;Wrida 331.34, vrnw.rrziamEbwashN.gpv
~IT,r, A~ERK Jffic~ ~ih~Clerk~micmibeachfl.gov
Tes- 3~5.5''3.7d11 ,Fax: 3~'~.573J25~
1 understand that no #ater than Qctober 1st of each veor, 3 must fi#e the fa{#owing
forms, pursuant to Section 2-485 of the AAiami Beach City Cade, with the City C#erk's
Offiee for al# active #abbying issues.
1 ~ E.abby'sst Expenditure farm
2~ aisc#asure Farm
Fai#ure to fi#e these forms an a time#y basis wi## resu#t in my name being transmitted to the
Miami-fade County Commxssian on Ethics and for Bade via#ation evo#uation.
In addition, once on issue I have registered to #obby an has been resolved, # am required
tc~ immediate#y notify the City C#erk's C)ffice of #ob#~yist withdrawa# in writing.
Signature: Date: