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Robert S. Fine - Delphine Dray~. m ~-1,AMIBEACH City of Miami Beach Office of the City Clerk 1704 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM Lobbyist means ell persons employed or retained. whether paid'ot riot, by a principal who seeks to encourage the passage. defeat ormodificatlon of any ordinance, resWutton, action or deasion or any commissioner; any act~r-, derasmn, recommendation of the City Manager or any city board or committee; a any action, derrsian or recommerMation of arty tyty personnel during the time period of the entire decision-making process on such anon, decision or recommendation that foreseeably wiU be heard or rev~vad by the city commission, or a sty board or wmmlitee. The-tens specifically includes Ore principal as welt as any employee engaged in lobbying adividea The term °Lobbyist8° has.apecttic a:etuslona. Pteasa refer to ordinance 2004-3435. Fine Robert S. NAME OF LOBBYIST: (Last) (First} (M,I) 1221 Brickell Avenue, Miami, Florida 33131 BUSINESS NAME AND ADDRESS (Number ar~1 Street} (City) (State} (Zip Code) 305-57s-0826 305-951-5826 finer~aw.t:om TELEPHONE NUMBER: FAX NUMBER: EMAtL• L LOBBYIST RETAINED BY: Delphine Dray NAME OF PRINCIPAUCUENT: 2740 N. Bay Road Miami Beach FL 33140 BUSINESS NAME AND ADDRESS (Number and Street} (Coy) (State) (Zip Code) _(7$fij 999-6027 TELEPHONE NUMBER: FAX NUMBER: (OptlonaQ EMAIL: (Optional) a or • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: • IDENTIFY At.L PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 596 OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSH{P OR TRUST: pubUcly Traded Corporation u.SPECIFIC LOBBY ISSUE: ~~- Building, zoning and floodplain variance issues. a ~ ~O ~• ~c ~~ nt. CITY AGENCIESlINDIVIDUALS TO BE LOBBIED: (Pursuant to City Code section 2-482(8) include a statement of the extent of any btts(rress, financlat, familial, profasslonal or other relationship, giving raise to an appearance of an Impropriety, w(th any City pertionnt3t sought to bs lobbied; further, pursuant to City Code Bastion 2- 482(a)(4) inctude a statement of any contractual relationship (paid or unpaid) from 12 months preceding the commencemattt of service of City personnet to be lobbied.) A Full Name of Indivtdttai tfe B An Flnanc~ Familial or Professional Retationshl Building Department /Fire Department Board of Adjustment Planning and Zoning Department, Public Works City Manager's Otf'ice Historic Board Board, Planning Board Flood Plain Management Board r i ^~ jkil ~~~' ~.1 t , ,:, i w :~~d ~.: =4 d ~ J ~~ ,~ / I r N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST CO E TIO~ ISCLOSE WHETHER HOCKEY,. FLAT RATE OR OTHERJ: A) LOBBYIST DISCLOSURE: (Required) $~0 Hourly ~ 5,~~ \ ~G' B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ~ Hourl (~Q ~r (Raouiredl. Y S.ti " The following Mformation must be answered: L 1 } Pursuant to Miami Beach City Code Section 2-488 Entitled °Prohibited Campaign Contributions By Lobbyists On Procurement Issues°: u Yes X No: Are you lobbvinrr on a present or pending bid for goods eguipmeM or services or on a present or pending award for roods equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues°: X 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 represerrtative of a no~for-profit corporation or entlty without special compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or apposition to any item, shall register with the dark as required by this section but, shall not be required to pay any registration fees. Q Yes X No• Are you reAresentina a not for-nrotit corporation of errtity without scar I compensation or rieimbun3ement.. . V. SIGNATURE UNDER OATH: Signature of Lobbyist: Signature of PrincipaUClient ~ VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: L'1' Produced ID Form of Identification Ikf Persanaliy known (Lobbyist) ~ Produced ID ~,~ Form of identification I.y Personally known (Principe!} Vil. 5IGNATURE AND STAAAP OF NOTARY: State of Florida, Courrty of Miami-Dade Sworn tq and subscribed.before me of State of Florida, County of Miami-Dade Swa~ ubscri befor me NOTARY PtTBLIC~TATE 8F FLORIDA This ay of 010 .•~•~~~~• Karen Denis ':Commission # DD836849 Si ature of Public olary - e of Fl I ` Exp>res: N0~ 11, 2012 Notarization of P nci al's signature ~ ~axv e~n~c B°NDING C0., INC. nnual Re istratton fee: Yes 9 [ I ( j No Amount Paid Lobbyist RegistraNan Form received and verified by: ,,,,_ :'+ «LLi:rr':9,d)598Y:iir~tuU6ycst ita~yrstratton Farm 32709.doc ~~ V V~ I'1° ~ V \L 1 _MCR d Date Patd Ravlsed 03/27'/2008 I do solemnly swear that ail of the foregoin facts are true and correct and that I have Head or am familiar with the provisions contained in Section ofiamt'itMode and ail reporting requirements.