Lucia Dougherty (2)~j~ z l~ - ~-
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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 w retained, whether paid or not, by a princlpal who seeks to encourage the passage, debt w modification of
any ordinance, resolution, aclion or decsion of any commissioner, any action, decsion, recommendation of the City Manager w any dry board or
committee; w any action, decision or recommendation of any city personnel during the time period of the entire decision-making process on such
action, decision w recommendation that fweseeably will be heard w reviewed by the city commission, w a sty board w committee. The term
apeclfically includes the princlpal as well as any employee engaged in lobbying activities. Tire term "Lobbyists" Irss specific exGusfons. Please
refer to Ordinance 2004343lt.
DOUGHERTY LUCfA A.
NAME OF LOBBYIST: (Last) (First) (M.I)
Greenberg Traurig 1221 Brickell Ave. Miami FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Cods)
(305) 579-0603 (305) 961-5603 doughertyl@gtlaw.t:om
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
AVP Miami Beach, LLC, Sole Member of Atlantic View Partners
NAME OF PRINCIPAUCLIENT:
4333 Collins Avenue Miami Beach FL 33140
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-532-2266
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
out this section ff principal Is a Corporation, Partnership or Tnist [Section 2x182 (c)]
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Jacob Neiss
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY ISSUE:
Zoning Approvals for 4218 Collins Avenue
Issue to be lobbied (Describe in detail):
Ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: (Pursuant to Cily Code section 2r/8a(g)
Include a statement of the extent of any business, Fnancial, familial, professional or other relationship, gluing raise to an
appearance of an impropriety, with any Clty 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 seMce of City personnel to be lobbied.)
A Full Name of Individual tie B An Financial, Familial or Professional Relatlonshi
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rV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE VYHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
$675.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMP NSATION):
(Required). I 675.00 per 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 ®No: Are you lobbying on a present or pending bid for goods. equipment or services. or on a
present or pending award for goods. equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues°:
^ Yes ®No: Are you lobbying on a pending application for a Development Agreement with the City or
application for change of zoning map designation or change to the City's Future Land Use
Map?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definifion of
"IobbyisY' as set forth in Section 2-481 above) who only appears as a representafrve of a not 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 ®No: Are you representing anot-for-arofit coraoration or entity without special comaensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of Principal/Client:
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VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
~, ^ Produced ID ~ Produced ID
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~ Form of Identi on Form of Identification
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• ~` VII. SIGNATURE AND STAMP OF NOTARY:
°~ ~ State of Florida, County of Miami-Dade State of FI rida, C of Miami-Dade
Swom to a~ubscxi before me
This 22 day of 20Q~ Swom ub d before me
This day
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ign ub ' tary_,.State of Florida Signatu ublic Notary - Sta "
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Notar za n of Lo is 's signature No n of Principal's sig
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TO BE COMPLETED BY CITY CLE STAFF ONLY
Annual Reglstratlon tee: [ ]Yes [ ] No Amount Paid S MCR Date Paid
Lobbyist Registration Fonn received and verified by:
F:\CLER~LOBBYIST~Lobbvist Registration Form 32708.doc Revised 1
~4UL V GONZALEZ
AY COMMISSION # DD941224
EXPIRES November 18, 2013
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I do solemnly swear that all of the foregoing facts are true and correct and that ~+6e read or am familiar with the
provisions contained in Section 2~2 of the Miami Beach City Code an~,aib rep n requirements.
m MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CIERK Office CityClerk@miamibeachfl.gov
Tel: 305.673.7411 ,Fax: 305.673.7254
LOBBYIST NAME: Lucia A. Dougherty
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 wil! 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 immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
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Signature: Date:
F:\CLER\LOBBYIST1Lobbyist Registration Form 32708.doc