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Robert S. Fine - Laurie F. Golub 1 -W CI.J� i I A 0f BEACH 50 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 Mcloager 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. Fine Robert S. 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) 305-579-0826 305-961-5826 finer @gtlaw.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: Laurie F.Golub NAME OF PRINCIPAL/CLIENT: 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 2.462(c)] o NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: Laurie F.Golub. ( r_' U4'aj wrad • IDENTIFY ALL PERSONS HOLDING,DIRE QTLY R INDIRECTLY,A 5%OR ORE OWNERSHIP INTER ST IN SUCH CORPORA ION PARTNERSHIP OR TRUST: -. k i' i . II.SPECIFIC LOBBY ISSUE: Redevelopment,and licensing as applicable of the Shore Club Issue to be lobbied(Describe in detail): III.CITY AGENCIESIINDIVIDUALS 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 sub'ect 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. Floodplain Management Board 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 tiled. Sec 2-482 Any Financial,Familial or Professional Relationship i . 1w 1F:ICLERI$ALL1aF0RMSIL0BBYIST FORMS\Lobbyist Registration Form.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) Hourly$595.00 B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST.COMPENSATION): (REQUIRED). Hourly$595.00 Thelollowing information must be answered: 1) Pursuant to Miami Beach City Code Section 2.488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues": _YesEjlo: 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": _Yesomo:. Are you lobbying on a pending application for a Development Aureement,with the City or application for chancre of zoning map designation or chance to the City's 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✓�lo: Are you representina 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 SIGN ED.STATEME_NT 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 TWRE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist I do solemnly swear that all of the foregoing facts are nd co t and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and a I rep in a reme s Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: S Produced ID ;�.�'511�,f ;•., Produced ID Form-of Identification = '= Form o IOVINO State of New York No.01106260404 _±, Personally known(Lobbyist) -X Personally known(Princ ified in Queens County My Commission Expires April 30,;2016 VII. SIGNATURE AND STAMP OF NOTARY: A:a� State of Florida,County of Miami-Dade „ State of ,County of MWW i-)ade a Sworn tq�nd subscribed before me �' �Z Sworn and ubscribed before me This " day of _ 1� H a '$ ay of_ ,201 T Ifl rn w m 'N.N R1 €g ature €c of State Florida „ H Signature of Public Notary—State offloWL arizatio of Lobbyist ignature N.o! Notarization of Principal's signatur �t/� TO BE CO CLERK'S STAF O L Annual Registration fee: { J Yes[ ]No Amount Paid S MICR ITP I I Patel Lobbyist Registration Form received and verified by: F;\CLEP\$laLL arm WNW\LOSIIAIYIST FORM:\LobPyir' t:Annual Regf-oration Form,doc Revised 1/22/2014 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov CITY CLERK Office Rafael E.Granada, City Clerk CityClerk @miamibeachfl.gov Tel:305.673.7411 ,Fax:305.673.7254 LOBBYIST NAME: Robert S. Fine 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 2-485(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$50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify -the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, who fails to file the required Statement by April 301'of each y ear,shall be automatically suspended from lobbying until all fines are paid, unless the fine has been appealed to the Miami-Dade County Commission on Ethics and Public Trust. 0 ---\-b zesty Signature: Date: F:ICLERI$ALL1aF0RMSIL0BBYIST FORMSlobbyist Registration Form.doc M"Iscellaneous Cash Redeipt CITY OF MIAMI BEACH No. ❑ Cash ❑Credit-Card ®:0— # f;;. $ 20 Received Of, Address A-A Az- ._ (THIS INFORMATION MUST.BE COMPLETED) Office of Finance Director By r Account Number. Preparer. F Dept. G .i C J' iF N -j —� T C7 fy - Z3- =. L C CD 1-4 :3 PV p c t CD C-3 ---4 3£: CO C-? 61f `< 7--Mz3C.0oC.0 - C7 t33 m -IZL- CS C) N 0) . .... o r- v 1, CD �, ,--t = C37 Cf1 - P%a Ca -j- Cr.) 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