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Fisher Island Hold, LLC 11/19/1 . . \ CITY OF MIAMI BEACH OmCE OF THE CITY CLERK 1700 Convention Center Drive Miami Beach, FL 33139 cityclerk@ci.miami-beach.fI.us AFfIDAVIT 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 ANY em BOARD OR COMMmEE; OR ANY ACTION, DECISION OR RECOMMENDATION OF ANY PERSONNEL DEFINED IN ANY MANNER IN THIS SECTION, DURING THE TIME PERIOD OF THE ENTIRE DECISION-MAKING PROCESS ON SUCH ACTION, DECISION OR RECOMMENDATION THAT FORESEEABL Y WILL BE HEARD OR REVIEWED BY THE em COMMISSION, OR A em BOARD OR COMMITTEE. THE TERM SPECIFICALLY INCLUDES THE PRINCIPAL AS WELL AS ANY AGENT, ATTORNEY, OFFICER OR EMPLOYEE OF A PRINCIPAL, REGARDLESS OF WHETHER SUCH LOBBYING ACTlVmES FALL WITHIN THE NORMAL SCOPE OF EMPLOYMENT OF SUCH AGENT, ATTORNEY, OFFICER OR EMPLOYEE. EACH PERSON WHO WITHDRAWS AS A LOBBYIST IS REQUIRED TO FILE A "CERTIFICATE OF WITHDRAWAL." 1) Lobbyist Name: Dougherty Lucia Last Name Rrst Name A. Middle Initial Business Phone (305) 579-0500 Message Phone (_) Business Name and Address: Greenberg Traurig, P .A. 1221 Brickell Avenue No. Street Miami Suite Florida 33131 City State Zip Code Email Address:doughertyl@gtlaw.com 2) Principal Retained by: Fisher Island Holdings, LLC One Fisher Island Drive If different from above Street Suite Fisher Island Florida City State Zip Code (a) If a corporation, partnership, or trust, identify and provide the address for the chief officer, partner, beneficiary or interests. 3) Subject Matter (Describe in Detail): Hazelwood Apartments, Phase Development Project - DRB approval for multiple family units. 4. ,Identify each individual (Commissioners, Board, COmmittee, Authority member or City staff) to be lobbied: Design Review Board 5. The subject matter in number three (3) above is to be considered at the meeting of (Identify each entity or individual): 0 The City Commission on .2001 0 City Commission Subcommittee on .2001 0 City Staff on .2001 0 City Board or Committee on .2001 0 Personnel on .2001 0 Identify Others on .2001 6. State the extent of any business, financial, familial, professional or other relationship which exists with any individual identified in number (4) above: ON OCTOBER 1 sr OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. I do solemnly swear that all of the foregoing facts are true an with the provisions contained in Section 2-482 of the Miami requirements. Signature of Lobbyist: o Personally known o Produced ID correct and that I have read or am familiar ch City Code as amended, and all reporting Identify o Did take an oath, or o Did not take an oath State of Florida, County of Miami-Dade Sworn t f(d sUbscri'X5 before l1Je This day of Lt<rnW r. 2001. N tary or Deputy Clerk LEYLA M SALAS NarARYPUBUcsrATE OF FLORIDA COMMISSION NO. DD060084 ON EXP. SEPT' 24,2005 If Notary, print, stamp or type as commission /' Registration: t 1 ACCEPTED If rejected, state reason: / Registration fee paid: [ 1 Yes [ ] No Yl Not-for-Profit Organization [ 1 Cash [j..e1leck MeR # FOR CLERK'S USE ONLY [ 1 REJECTED DATE: I/'/ DATA ENTRY DATE: .2001 ENTERED BY: