Alfredo J. Gonzaleza.9.r m.~~F„
m MIAMIBEACH
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 Jn lobbying activities. The term "Lobbyists" has specific exclusions. Please
refer to Ordinance 20043435.
Gonzalez Alfredo J.
NAME OF LOBBYIST: (Last) (First) (M.I)
1221 Bllckell Avenue, Miami, Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-579-0588 305-951-5588 gonzalezaj@gtlaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
Burger King Corporation
NAME OF PRINCIPAUCLIENT:
5505 Blue Lagoon Drive Miami FL 33126
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-378-3000
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:
Craig S. Prusher
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
Publicly Traded Corporation
II.SPECIFIC LOBBY ISSUE:
Burger King /Whopper Bar Building Issues
Issue to be lobbied (Describe in detail):
ttl. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to city Code section 2-4s2(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 An Financial, Familial or Professional Relationshi
Building Department /Fire Department Board of Adjustment
Planning and Zoning Department, Public Works City Manager's Office
Historic Board Board, Planning Board Flood Plain Management Board
IV. DISCLOSURE OF TERMS ANO AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $400.00 Hourly
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): $400.00 Hourly
(Required).
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 taendina bid for aoods. eauinment or services. or on a
present or pending award for aoods. eguinment 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 lobbvina on a uendina aoolication for a Develoument Agreement with the City or
apalication for change of zoning mau designation or change to the Citv'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 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 snot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 7sT OF EACH YI
STATEMENT UNDER OATH. LIST
IN THE CITY OF MIAMI BEACH F
EVEN IF THERE HAVE BEEN NO
I do solemnly swear that all of~ie
provisions contain~in.~Secti 2-~
Signature
Signature of Pr cipal/Clienf~_~
VI. LOBBYIST IDENTIFICATION:
facts are true an6,Eorrect and that I have read or am familiar with the
liami BeachBeach City 'ode and all reporting requirements.
^ Produced ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
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S ~ $ 6 State of Florida, County of Miami-Dade
Swom to and subscribed before me
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^' Notarization of Lo vrs s signature
PRINCIPAL IDENTIFICATION:
0 Produced ID
Form of Identification ~„~,,,,
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Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid $MCR # Date Paid
Lobbyist Registration Form received and verified by: ~,~~,~ ~~f
F:\CLER\LOBBYIST\LObbyist Registration Form 32708.doc ~ R8Vi5@d 03/27/2008
m MIAMIBEACH
Cihr of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachA.gov
CITY CLERK Office
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME:
Alfredo J. Gonzalez
CityClerk~m iam ibeachfl.gov
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 immediate notify the City Clerk's Office of lobbyist withdrawal in writing.
February 10, 2010
Date:
F:ICLERILOBBYISTILobbyist Registration Form 32708.doc