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Frank Demandt/Walgreen Co.~~o D ~ City of Miami Beach Office of the City Clerk N~ ~' 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. Demandt Frank NAME OF LOBBYIST: (Last) (First) (M.I) Demandt Architecture, P.A. 6710 SW 80`" Street Miami Beach Florida 33143 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 665-5250 (305) 665-5251 frank@demandtarchitecture.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 • 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: A) Full Name of Individual/Title* B) Any Financial, Familial or Professional Relationship Planning and Zoning Department Staff, HPB, BOA, City Commission None S£ •~ tT~ ~,~ ~ ~y~ 1 ~~ .~ LJ` .-rd 1,,,~1 5f~ * 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 t/Of/RLY FLAT RATE OR OTHERx A) LOBBYIST DISCLOSURE: (Required) ~ 150 00 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 150 00 The following inforrnatwn must be answered: 1) Pursuant to Miami Beach Gty Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": o Yeas X No• A_re you lobbying on a present or,~gg~.~,g,bid for goods, eouipment or services, or on a present or oendina award for goods, eouipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": a nc N 11 LL ~ ~ O ~ ~ o° `~ ~ ~o U 's too avE~ 0 o2~~a Z U ~ W ~~~ °v. s~' Map3 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 wrporation or entity without spedal compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any item, shall register with the dark 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 A5 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. A n L \ ~ Signature of Lot~byist I do solemnly swear that all of the foregoing facts are true and rnrrect and that I have read or am familiar with the provisions fined in Section 2 2 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ^ Produced ID ^ ProducedID Form of Identification Form of Identification ~,,,. Personally known (Lobbyist) ^ Personally known (Principal) SIGNATURE AND STAMP OF NOTARY: of Florida, County of Miami-Dade ~ to and subscribed before me Z-l day of ~y , 20 D9 State of Florida, County of Miami-Dade Swom and subscribed before me This day of . 20_ signature of l~Iblic Notary -State of Florida Signature of Public Notary -State of Florida ,Notarization of Lobbyist's signature Notarization of Principal's signature FOR CLERK'S USE ONLY Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # Date Paid ~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOl/RLY, FLAT RATE OR OTHERt A) LOBBYIST DISCLOSURE: (Required) $ .00 Der hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ .00 Der 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": present or pending award for goods, eaui~ment 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 oendina aoulication for a Development Agreement with the City or aoolication for change of zoning map designation or change 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 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. 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 Princi VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID ,~lA Form of Identification Form of Identification ~ o~ - Personally known (Lobbyist) Personally known (Principal) .., ~ -~ o ~;• Q ~ J, u' VII. SIGNATURE AND STAMP OF NOTARY: `l' ~ N {- p ~- State of Florida, County of Miami-Dade tl.\-6uatS U4t<t State of Flernia, County of-~4ianai=Bade m ~ ~ --~ Q X Sworn to and subscribed before me Sworn and subscribed before me Q ~ "'_'L This day of , 20_ This l4Y" day of ~~, 20~ ~ w m o C 4 v~ Q Signature of Public Notary -State of Florida Signature of P is Notary -State of Florida l.L it ~ ~ ~ ~ 4 • Notarization of Lobbyists signature Notarization of Principal's signature ~ ° > _ ~5 FOR CLERK'S USE ONLY Annual Registration fee: [ ]Yes [ ] No Amount Paid __s_L jJ_~ MCR # Date Paid ~ d ~ ~ Lobbyist Registration Form received and verified by: _ Entered By: F:\CLER\;ALL\MARIA-M\Labbyist\LOBBYIST fORM OS.da Revised 12/08/04 Lf~/ ~~` - :; ~p ~ s• ~.,. ~ ., City of Miami Beach, 1700 Convention Center Drive, Miami Seoch, Florida 33139, www.miamibeachfl.gov CITY CLERK Office CityClerk@miomibeachN.gov 7e1: 305.673.741 1 ,fox: 305.673.7254 LOBBYIST NAME: ~KANt~ 'D sE M A N IDT 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, 1 am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. 07- 2?• oq Signatu Date: f~F ~ - :. ~.._.. ~ ,..