Robert Finem MIAMIBEACH
u tc~ a~ 1~°~s I
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 mod cation 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 20043435.
Fine Robert S.
NAME OF LOBBYIST: (Last) (First) (M.I)
1221 Brickell Avenue, Miami, Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-579-0826 305-951-5826 finer@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):
iii. 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
~~
N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHEit):
A) LOBBYIST DISCLOSURE: (Required) $545.00 Hourly
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): $545.00 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 pending bid for goods. eauioment or services. or on a
present or uendina award for goods. eauioment 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
"IobbyisY' as set forth in Section 2-481 above) who only appears as a representative of snot-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:
I do solemnly swear that all of the foregoing facts are true and correct and that 1 have read or am familiar with the
provisions contained in Section 2-~8~'i7 the i mi ~ i o d all reporting requirements.
Signature of Lobbyist: ~ '~
Signature of Principal/Client: C./t--4.. ~„_ ~.~,~
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID ~ ~ Produced ID
E ~ $
8 Form of Identification Form of Identification ,,;~,,,,
...__
a,: 3,
~ ~ ~ Personally known (Lobbyist) ~ Personally known (Principal) ~~~p
`
;11*
VII. SIGNATURE AND STAMP OF N TARY:
O
~~ ~
State of Florida, County of Miami-Dade
S
d
b
ib
d b
f
State of Florida, County of Miami-Dade
d
i ~o
z N ~ o
wum to an
su
scr
e
e
ore me
2010
Thi subscr
Swor ~n
bed before me
Thi
~
f F
?h ~ ~ o
s o , ay o
s
f
YUQ/y~2010 s~ z ~
-.
r°
Sign -State of Florida ~iLCX-~
Signature o Public otary -State of Florida ~ o v
~
~
No ization o Lobb is srgnature Notarization of Principal's signature ~
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY '~'
Annual Registration fee: [ ]Yes [ ] No Amount Pai MCR # ~~?i,,,r~_Date Paid
Lobbyist Registration Form received and verified by: 1
F:\CLER\LOBBYIST\Lobbyist Registration Form 32708.doc~ Revised 03/27/2008
.~
Signature of Lobbyist
m MIAMIBEACH
Cihr of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, viww.miamibeachfl.gov
CITY CLERK OfFice CityClerkC~miamibeachfl.gov
Tel: 305.673.7411 ,fax: 305.673.7254
LOBBYIST NAME:
Robert S. Fine
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 immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
' ~ February 10, 2010
Signature: Date:
F:\CLERILOBBYIST1Lobbyist Registration Form 32708.doc