Robert Brown/Walgreen Co.~ ~..
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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.
Brown Robert
NAME OF LOBBYIST: (Last) - (First) (M.I)
Robert Brown Architect 6710_ SW 80"' Street, Suite 101 Miami Florida 33134
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 622-1940 (305) 662-1327 o4adare@aol.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/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title* B) Any Financial, Familial or Professional Relationship
Planning and Zoning Department Staff, HPB, BOA, City
Commission None
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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.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL);
FLAT RATE OR OTHERx
A) LOBBYIST DISCLOSURE: (Required) $ 125 00
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ~ 125 00
Tice following information must be answered:
1) Pursuant ~ Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^ Yes X No• Are you lobby~no~,~present or pending,bid for goods equipment or services, or on a
present or pgnding award for goods• equipment or s!~%ice?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
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 Sedtion 2-481 above) who only appears as a representative of anot-for-profit
corporation or entity without spedal compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition tD any item, shall register with the deck as required by this
section but, shall not be required to pay any registration fees..
^ Yes X No• Are yQ~gpr+esenting a not-for-profit corporation or entity witfiart special compensation
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 A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURESI~IR~ON~PEN ON DURING THE
REPORTING PERIOD. //// //~
nature of Lot~byist
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I do solemnly swear that all of the oregoing f are true and correct and that I have read or am
familiar with the provisions con in 2-482 of the Miami Beach City Code and all reporting
requirements.
ature of Lobbyist:
S' nature of Principal/CI'~ent:
LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID ^ Produced ID
Form of Identfication Form of Identification
Personally known (Lobbyist)
SIGNATURE AND STAMP OF NOTARY:
fate of Florida, County of Miami-Dade
wpm t and subscribed fore me
is ~_day of __~lJ ~_„~ 20 0~
Signature o ry -State of Florida
Notarization of Lobbyist's signature
Annual Registration fee: [ ° ]Yes [ ] No
^ Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This day of , 20_
Signature of Public Notary -State of Florida
Notarization of Principal's signature
FOR CLERK'S USE ONLY
Amount Paid ~_ MCR # Date Paid
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERt
A) LOBBYIST DISCLOSURE: (Required) $ oer hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ ger 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":
^ Yes X No• Are you lobbvina on a present or pendina 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 lobbying on a pendina application for a Development Agreement with the City or
application for change of zoning map designation or chanae to the Citv's Future Land Use
Mau?
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 entity without special compensation
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 COMPENSATION DURING THE
REPORTING PERIOD.
Signature of Lobbyist
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 and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST I
i~ 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 . 20_
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
PRINC LIDENTIFICATION:
^ Produced I
For of Identification _ _ °
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'~ Personally known (Principal) Q N
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State of Florida, County of ~P4ia~rti-Baste Q ~ '^ W
Sworn and subscribed before me
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This ~i
day of suNE , 20~ ~ ~ ~
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Signature of Public ry -State of Florida 0
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Notarization of Principal's signature
FOR CLERK'/S~S~NLY ~ z ~~
Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # Date Pai ,~~ ~J
Lobbyist Registration Form received and verified by: Entered By: d /~"~wri
F:\CLER\$ALL\MARIA-M\LObbyist\LOBBYIST fORM OS.doc Revised 12/08/04
City of Miami Beach, 1700 Convention Center Drive, Miomi Beach, florido 33139, www.miomibeocfiN.gov
CITY CLERK OfFice CityClerk~miomibeochN.gov
Tel: 305.673.741 1 ,fox: 305.673.7254
LOBBYIST NAME: Ra'~~i ~'f~.o ~^~
I understand that no later than October 1st of each ear, 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
2j 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 1 have registered to lobby on has been resolved, I am required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
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Signature: Date:
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