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Alfredo J. Gonzalez / Lennox Miami Corp. J ,t-It, ��J, JAI; IM MIAMI BEACH 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 modification 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 2004-3435. Alfredo Gonzalez J. NAME OF LOBBYIST: (Last) (First) (M.I) Greenberg Traurig, P.A. 333 Ave.of the Americas,44th FI Miami FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-579-0588 305-961-5588 gonzalezaj@gtiaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact inforrnatfon changes:address,phone,or e-mail address. 1. LOBBYIST RETAINED BY: Lennox Miami Corp. NAME OF PRINCIPAUCLIENT: Lennox Miami Corp. 29919 Street Miami Beach, FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) Fill out this section if principal is a Corporation,Partnership or Trust[Sectlon 24182(c)] • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: Diego M. Agnelli • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 59%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: u5PEC1F.1C.LOBBY ISSUE:: HPB Modifications to Peter Miller By Lennox Hotel Issue to be lobbied(Describe in detail): Ill.CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(a)(4)Include the commissioner or personnel sought to be lobbied,and whether the lobbyist has entered Into any 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 eneral nature of the subywt contractual relationship. Sec 2-482(a)(4)Full Name of Individual and Contractual Relationship(Explain) YES NO title of person to be lobbied Board of Adjustment,Dept of Public Works,Historic Preservation x City of Miami Beach Commissioners,City Manager,City Attomey x Planning Board, Design Review Board x Pursuant to City Code Section 24W(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 i�10 'k 113 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc U � �1 � � C7 I IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $450.00 Hourly B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (Required). $450.00 Hourly The following Information must be answered: 1) Pursuant to Miami Beach City Code Section 2488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues": Yes X No: Are you lobbyina on a present or pendina 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 X No: Are you lobbying on a pending application for a Development Agreement with the City or application for change of zonina 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 tees. Yes X No: Are you representing a not-for-profit corporation or entitv without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON FEBRUARY 28th OF EACH YEAR EACH LOBBYIST SHALL.-SUBMIT T THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURE WELL A"OMPENZAMON RECEIVED, IN THE CITY OF MIAMI EACH FOR THE PRECEDING ALENDAR YEAR. A STATEMEN HALL BE FI EN IF THERE HAVE EN NO EXPENDITURES O COMPENSATION DURING THE REPORTING PERI Alz=—� f ' I do solemnly swear that all of th oregoing cts ar rue rrect and ave read or am familiar wi a provisions contained in Section 2-482 of the Mi Signature of Lo yist: Signature o rinci I/Client: VI. LO BYIST IDEMI A ON: ""• PRINCIPAL IDENTIFICATION: =� Produced ID = °- Form of Identification °; • '•`� .un.. .� Not�rQtiotiraf�l, � z Ser to �Em�tkd�bt: n=3 SA Comriii4ggian.EE�172059 -IQ—J--.Personally known(Lobbyist) a 3 C w y 64'lY3fWall H 3 c VII. SIGNATURE AND STAMP OF NOTAR m m S. y a State of Florida,County of Miami-Dade o m N N State of Florida,County of Miami-Dade Sworn to a d subscribed before me d ° " °= m Sworn aril subscribed before me v o „ r- 3VV�.13 This s day L 2012 0 CO g °� This _ day of 2012 if �:v T N ly 40 r,3 O BF - C d i natur ublic late of Florida N d Signature of Public Notary—State of Florida Note zat n o Lob ylst's signature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ O MCR# Date Paid Lobbyist Registration Form received and verified by: FACLER\$ALL\aFORMSU.OBBYIST FORMS1Lobbyist Registration Form doc v I F:\CLEI listration Form.doc Revised 04/27/2012 MAMIBEACr-1 City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeacho.gov CITY CLERK Office Rafael E. Granada, City Clerk CiryClerk @miamibeachfl.gov Tel: 305.673.741 1 , Fax:305.673.7254 LOBBYIST NAME: I understand that no later than February 28 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-Dade County Commission on Ethics and for code violation evaluation. In addition, once an issue I have registered to lobby on has been resolved, or I am no longer lobbying on that issue or for that principal, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. Pursuant to Section 2-488(d),the City Clerk shall notify any lobbyist(or principal)who fails to timely file a Statement and in addition to any other penalties which may be Imposed as provided in Section 2-485.1, a fine of$50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, who falls to file the required Statement by April 30th, 2012, shall be automatically su pended from lobbying until all fines are paid, unless the fine has been appealed to th mi-Dade ounty Commission on Ethics 7_�Publi Trust.12 Sig u D te. C:\Users\clerhat\HppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outiook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc