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Alfredo J. Gonzalez (3)y ° ~~,w° m MIA,MIBEACH 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 inGudes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has speclflc exclusions. Ptease refer to Ordinance 2004.3435. Gonzalez Alfredo J. NAME OF LOBBYIST: (Last) (First) (M.I) 1221 Brickell 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: Please see attached NAME OF PRINCIPAUCLIENT: Go Column Financial, Inc. 11 Madison Avenue, 10th Floor, New York, NY 10010 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 212-325-2000 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: Stephen Yankauer • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: u.SPECIFiC LOBBY ISSUE: 2301 Collins Avenue, Miami Beach: Code Violations and C.U.P. Issue to be lobbied (Describe in detail): ~...,. IIL CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to City Code section z•aa2(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 Building Department /Fire Department Board of Adjustment Planning and Zoning Department, Public Works City Manager's Office Historic Preservation Board Flood Plain Management Board o~ :z ~~d zz g.~.~ o~oi 5'~ IV. DISCLOSURE OF TERMS AND 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 Hourl ~oe.,..~.e.~~ Y 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 lobbving on a present or pending bid for aoods. eauipment or services, or on a present or pending award for aoods, equipment 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 pending application for a Development Agreement with the City or application for change of zoning map 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: nu ~i+r~nre ,. S7 nr rwnu v~ I do solemnly swear that all o the foregoing facts are true and 6orrect and that 1 have read or am familiar with the provisions contained in Secti 2-48 f the Miami Beach City Code and all reporting requirements. Signature of Lo yist: Signature of Pn apal/Clien . VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ~=~e }~ $ ^ Produced ID ~ Produced ID ~- Form of Identification Form of Identification Personally known (Lobbyist) L~' Personally known (Principal) SHARON D. WILLIAMS ~~' ~ VII. SIGNATURE AND STAMP OF NOTARY: Notary Public, State of New York ~,y VD~L- vw yy ~ No. 01 WI6203907 State of Florida, County of Miami-Dade State of F~arida, County of Mie-~i-Bade Qualified in New York County Sworn to and subscribed before me Sworn subscribed efore me Commission Expires April 13, 20L This ~'Z day of ha.~~ , 2010 This lad o , 2010 Signa t of Florida Sign ture o ary -State of Florida Notarization o ~ob s ignature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes [ ] No Amount Paid $ lJ - MCR # 4 Date Paid Lobbyist Registration Form received and verifred by: ~:~Ct.ER>LOBSYIST~Lobtayist Registration Form 3270$.doc .Hi Revised 03/27/2008 ~ ', City of Miami Beach, i 700 Convention Center Drive, Miami Beach, Florido 33139, www.miamibeachfl.gov CITY CLERK Office Tel: 305.673.741 1 ,Fax: 305.673.7254 LOBBYIST NAME: Alfredo J. Gonzalez CityClerk@miamibeachfl.gov I understand that no later than October 1st of each y~ r, 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 immed~tely notify the City Clerk's Office of lobbyist withdrawal in writing. .2 •~~• rv Date: F;1CL.Ef2tLOBE3YISTtLobbyist Registration Form 32708.dac ATTACHMENT TO LOBBYIST REGISTRATION WSA South Beach, LLC; WSA Paradiso Associates, LLC; Sandy Lane Group, LLC; Sandy Lane Senior Mezz, LLC; Sandy Lane Senior Mezz II, LLC; Sandy Lane Junior Mezz, LLC; and Sandy Lane Residential, LLC MIA 181,070,645v1 2-12-10