Rob Curtis - Walgreen, Co G.. MIAMI BEACH
City of Miami Beach Office of the City Clerk ,
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM ��.
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Lobbyist means all persons employed or retained,whether paid or not, by a principal who seeks to encourage the p'14e`,,4e,feat pc modification of
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any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the City Manager and diiy �r
committee; or any action, decision or recommendation of any city personnel during the time period of the entire decision-making process on st ch
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 2004-3435.
Curtis Rob
NAME OF LOBBYIST: (Last) (First) (M.I)
The Curtis Group,Inc. 7520 Red Road,Suite M Miami Florida 33143
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)663-5800 (305)663-3444 rob @curtisplanning.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes.,address,phone,or e-mail address.
I. LOBBYIST RETAINED BY:
Walgreen,Co.
NAME OF PRINCIPAL/CLIENT:
Walgreen Co 104 Wilmot Rd MS# 1434 Deerfield IL 60015
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(847)315-2698 (847)315-4660
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:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: Publicly traded company on NYSE under symbol"WAG"
II. SPECIFIC LOBBY ISSUE:
Development approvals and permitting issues for property located at 7340 Collins Avenue.
Issue to be lobbied(Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4)include the commissioner of personnel sought to be lobbied,and whether the lobbyist
has entered into contractual relationship(paid or unpaid)with said city commissioner or personnel from 12 months preceding
such person's commencement of service with the city to the present date,stating the general nature of the subject contractual
relationship.
Sec 2482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to be lobbied
Planning Department and Building Department None X
Staff
HPB, DRB, BOA,City Commission,as necessary* None X
Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,familial or
professional relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner
or city personnel who is sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2-482 Any Financial,Familial or Professional Relationship
None.
*Unless an issue is legislative in nature,HPB,DRB,BOA,&City Commission members are not lobbied outside of a public hearing setting.
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FL,97-R47EOR
OTHER).
A) LOBBYIST DISCLOSURE: (Required) 54,400 Oat rate
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (Required)._ $4.400 Oat rate
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":
('I Yes X No: Are you lobbing 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":
nYes X 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 definition of"lobbyist" as set
forth in Section 2-481 above)who only appears as a representative 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..
F1 Yes X No: Are you representing a not-for-profit corporation or entity without special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 281i OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY LERK A SIGNED STATEMENT
UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF
IAMI BEACH FOR THE PRECEDING CAL NDAR YEAR STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN
NO EXPENDITURES OR COMPENSATION RING THE R P RIOD.
Signatur o st
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the
provisions contained in Se f -48Ygf the Miami Beach City Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID OFFICIAL SEAL
Form of Identification Form of Identific ti KAREN A KESSLER
ROTARY PUBLIC•STATE OF ILLINOIS
/Personally known (Lobbyist) ,)r Personally known (Principal) MyCOMMISSIONEXPIRES:09/24/i3
A
o 3VI SIGNATURE AND STAMP OF NOTARY:
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s w 5,t of Florida, County of Miami-Dade State of-f9irida, County o
y E rn to nd subscribed before me Sworn an ubscribed before me
a a, _day of , 20 17/ This ay of�_T��oU,AP/ 20(
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Z rcj ature of Public Notary—State of rids Signatur o Public Notary—State of G�t�nls
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arization of Lobbyist's ignature Notarization of Principal's signature
�j FOR C MCR ON Y
al Registration fee: ( ]Yes[ ]No Amount Paid # Date Paid
yist Registration Form received and verified by: Entered By:
Rewsed 1/11/2011
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City of Miami Beach, 700 Convention Center}nv<,h,tiami Beocr, Fieriao 3,'39 www,miamiceocn(1•00v
CITY CLERK Office Citv.CIeri4miomibeachf1.9ov
Tel:30S.673.7411 ,Pax.303.679,725A
LOBBYIST NAME:
I understand that no later than Februa�28th of each year, I must file the following form, 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 and Compensation Form
Failure to file these forms on a timely basis will result in my name being transmitted to the Miami-Dode
County Commission on Ethics and for code violation evaluation.
In addition, once an issue I hove registered to lobby on has been resolved, i am required to
immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
Sig ature: Date: