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Alfredo J. Gonzalez - Southgate Tower ApartmentsCity of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM lobbyist means all pereons employed or retained, whether paid or not, by a pdndpal who seeks to encourage the passage, defeat or modification of arty ordinance, resolution, argon or decision of any commissioner, any actlon, derision, recommendation of the City Manager or any dry board a committee; or any action, decision or recommendation of any city personnel during Ole Ome period of the entlre decision-making process on such edion, dedsbn or rxommendatton Drat foreseeady will be heard or reviewed by the dty commission, or a dry boam or commOtae. The term specifically includes the pdndpal as well es any empbyee engaged In lobbying adivitiea. The term "Lobbyists" has speenie ezeluelorts. Pbaee refer to Ordinance 20043435. Gonzalez Alfredo J. ~I NAME OF LOBBYIST: (Last) (First) (M.I) 1221 Bridcell Avenue, Miami, Florida 33131 I~ (state) 305-579-0588 305-951-5588 gonzalezajCgZgUaw.com I~ TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED SY: Southgate Tower Apartments c% Harry Nash NAME OF PRINCIPAL/CLIENT: I 6600 West Broadstreet, Suite 100 Miami Beach, FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zlp Code) 804-288-0011 804- Rta7AZ___ FAX • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Harry Nash • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5°~ OR MORE OWNERSHIP INTEREST SUCH CORPORATION, PARTNERSHIP OR TRUST: II.~s~Q~clFlc. to'~r-~"" u~? Southgate Tower Apartments request before the DRB Board I to nl. ryr,-1(a NCIE-SIINDIYIDUAL&"<~'OtrB~~< ~at BBIE , : (pursuant to city coda sactlon 2»te2tg) include a statement of the extent of any business, finandal, familial, professional or other relationship, giving raise to an appearance of an Impropriety, with any City personnel sought to be lobbied; further, pursuant to Cky Code Sectlon 2- 482(a-(4) include a statement of any contraduat relationship (paid or unpaid) from 12 months precedtng the commencement of service of City personnel to be -obbied.) ~ A FuII Name of Individual tle B An Finandal, Familial or Professional RaiaBonshi Building Department /Fire Department Board of Adjustment! Design Review Board Planning and Zoning Department, Public Works City Managers Otfit~ Historic Preservation Board, Planning Board Flood Plain Management Board J~ S N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $375.00 Hourly B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): $375.00 HOU11y (Required). The following information must be answered: 1j Pursuant to Miami Beach City Code Section 2088 Entitled "Prohibited Campaign Contribufions ey Lobbyists On Procurement Issues": ^ Yes X No• Are you lobbying on a present or oendina bid for goods equipment or services or on a AreseM or oendina 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": 3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of WobbyisY' as set forth in Section 2-481 above) who only appears as a representative of goof-for-profd corporation or entity without spedal cempensation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any item, shall register with the deck as required by this section but, shall not be required to pay any registretion fees. ^ Yes X No• Are you representing a not for-profit coporetion or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: I do solemnly swear a II of o f g provisions contain in Se Signature of Lobb s Signature of Principe Client w VI. LOBBYIST IDENTIFIC ON: ^ Produced ID ~° o o Form of Identification ~ ~ o Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed before me • This 2. da of 0 Sign e o rids • No rizaflon of nature reef and that I have read or am familiar with the and all reporting requirements. PRINCIPAL IDENTIFICATION: ~ Produced ID Form of Idenffication Personally known (Principal) Y~rq~n~a ~P-4~Yitp State offlonde, County of Mia+s+i-Dade Sworn an~ subscribed before me This day of ~- r~ _' 2010 Signs of P bile Notary -State of Fh Notarization f Principal's signature ~~I111111/rr ~~ Sri ~~~~~~~ ~':.PRFLi~~'% .; PUB10a ~4 '•. REO~M~,\SS~ON '. z = ~~~p~... pg{3~12 O~J` ~~rrnl lu~~~~ rcida TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registjatton fear j lies [ ,:[ Wo .Amount Paltl 5< "'-:MCIt ({ Date Pa)d i ~ Lobbyist Ragistiation Foini received and verlHed dy, _ F:ir~R\tASard51'1tAbbytstlaSon Farm 31708E .. ~ ~ ...~ ... _< IteW6ed~03/27/20D8 ~~ i . m MIAMIBEACH Oily of Miami Beach, 1700 Convention Cenfar Drive, Miomi Beach, Florida 33139, vnvw.miamibeachfl.8ov' CITY CLERK Office Tal: 305.673.7411 ,Fax: 305.673.7254 LOBBYIST NAME: Alfredo J. Gonzalez CityClerk~miamibeachfl.gov I understand that no later than October 1st of each veer, 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 fife 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. I~ . ~~-~ -- Date: F:ICLERILOBBYIST1Lobbyist Registration Form 32706.doc