Lucia A. Dougherty - Shore Club Property Owner LLC W�
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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.
Dougherty Lucia A
NAME OF LOBBYIST: (Last) (First) (M.I)
Greenberg Traurig,P.A. 333 SE 2nd Avenue,44th Floor Miami Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-579-0603 305-961-5603 doughertyl @gtiaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone,or email address.
I. LOBBYIST RETAINED BY:
Laurie F.Golub
NAME OF PRINCIPAUCLIENT:
Shore Club Property Owner LLC 600 Madison Avenue,15th Floor New York NY 10022
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
212-300=8018
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: Laurie F.Golub ca./V : jrC60
• IDENTIFY ALL PERSONS HOLDING DIR PT 4Y OR INDIRECTLY, 5%OR M,RE OWNERSHIP IN REST IN VQJ1(CORPORATION,
PARTNERSHIP OR TRUST: f'A
Ir.SPECI IC LOBBY ISSUE:
Redevelopment,and licensing as applicable of the Shore Club
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 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 subject 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 Board
City of Miami Beach Commissioners,City Manager,City Attorney,Fire Dept.
Planning Board,Design Review Board,Building Dept.,Planning Dept.
Pursuant to City Code Section 2-482(8)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 tiled.
IJ
Sec 2-482 Any Financial,Familial or Professional Relationship
t L19 117, 20 v
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
Hourly$750.00
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). Hourly$750.00
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":
_Yea2 No: Are you lobbying 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 Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes[Z]No: Are you lobbying on a vending application for a Development Agreement with the City or application for
change of zoning map designation or change to the CitVs Future Land Use Map?
3) Pursuant to Miami Beach City Code Section 2-482(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.
_Yes D4o: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR,EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES,AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature of Lobbyist
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 Section 2482 of the Miami Beach City Code and all repo ing re ements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFI ATION.��e_ ) ,l,P17 RINCIPAL IDENTIFICATION:
Produced ID
+°'°:"• ,,; Produced ID CHRISTINE M.IOVINO
F I§1019 of-New York
Form of Identification ' 0404
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%qb QValif ed in Queens County
)Personally known(Lobbyist) •�, .. •..• Personally kngffdg Expires April 30,2016
V11. SIGNATURE AND STAMP OF NOTARY:
State of Florida,County of Miami-Dade State of Vie,County of
Sworn t and subscribed before me �\� a Sworn andj ubscribed before me
This k- of O ,201 n t This 4FTav of 01
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I'gnature o ub' of f Florida o o_ ° Signature of Public Notary—State of fa
ar zation of Lobb i s signature Notarization of Principal's signatures
TO BE CO S ETC-Be I*CI CLERK'S STAFF ONLY
Annual Registration fee: [ j Yes( j No. Amount Pa fdCR aie Date Paid
Lobbyist Registration form recelved and verified by:
FORKS Lt'bbyig Id.tts'nuat lxs.vjktfation Fortyo.doc Revise 01 22/2014
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City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachf.gov
CITY CLERK Office
Rafael E.Granado,City Clerk CityClerk @miamibeachfl.gov
Tel:305.673.7411 ,Fax:305.673.7254
LOBBYIST NAME: Lucia A. Dougherty
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
g Y
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 2-485(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 fails to file the required Statement by April 301"of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
Signature: Date:
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