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Graboski, Thomas/CasuarinaOW of Miami Beach Office of the City Oerk 1700 Convention Center Drive, Miami Beach, FL 33139 Emall: dtycJerk~cL miami-beach.fi.us LOBBY[ST REGZSTRAT/ON FORM (Oty o~ Miami Beach, Oty Code Chapter 2, D~0n 3, Section 2-481) [] Check Box if an Amendment Graboski Thomas NAME OF LC~BYIST: (Last) (Flint) (M.[) DAq~ QUAL.[FZED AS LOBBYZST 4649 Ponce de Leon BouleVard, # 401, Coral Gables, FL 33146 BUSINESS ADDRESS: (Number and Street) (City) 305. 669. 2550 305. 669. 2539 (State) (Zip Code) mail @tgadesign. com TELEPHONE NUMBER: 1. LOBBYIST RETAINED BY: A & R Sobe, Inc. FAX NUMBER: EMA~L: NAME OF PRINCIPA~CUEN/: 1 Casuarina Concourser BUSINESS ADDRESS: (Number and Street) 305.665.9600 Coral Gables, FL 33134 (city) (State) (Zip Code) TELEPHONE NUMBER: FAX NUMBER: (OpUonal) EMA[L: (Optional) Fill out this section If prina~pal Is a Corporation, Partnership or Trust [Section 2-482 (c)] · NAME OF CHIEF OFFICER, PARTNER, {DR BENEI=]C~ARY: Allan Potamkin, Robert Potamkin · L/ST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A $% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Allan Potamkin, Robert Potamkin, Jeffrey Berkowitz SPEC~I~C LOBBY LqSUE: Signs for 5th and Alton . issue to be lobbied (Describe in del:ail); ~ AGENCZES/ZND/VZDUALS TO BE LOBBZED: A) Full Name of ]~ndivldual/TIUe B) RelaUonship City of Miami Beach, Planning Dept. FLA T RA TE OR OTHER): A) 'O.~O~URE: $130.00 per hour 8) PPJNC~PAL~DI~2LOSU~E(OFLOeBYISTCOMPEN~AT[ON): $130.00 per hour Pursuant to Ordinance No. 2003-3393 Amendtn~ Miami Beach Cit~ Code Chaoter 2, Article V~. Division 5 Thereof E~tltled "Camoalon Finance Reform" Via The Addition Of Code SecrJon 2-488 Entitled "Prohibit~ Camaalon Contributions By Lobbyists On Procurement XsmJes": 2) Are you Iobbvlnu mt a nmsent or ~endinQ bid for ~___~_s. eGuful:~It~or services, or on a ore~ or ;~r~lna .ward for ~o~ e~ulDment or ~ervice? Yes ~_~ Pursuant to Ordinance No. 2003-3395 Amending Miam~ Beach Cltv Code Chapter 2. Article VI! Division thereof Entitled "Camoal~n Finance Reform", Via The Addit[on Of Code Section 2-490 Entitled "Prohibi~.f~~ Cameaian Contributions By Lobbvis~ O~ Real Estate Develooment [ssue~"; A~_ ~re~ Iobbvlna on a =endlne amtli~_H_on for a Devek~_ment Aareement with the crcv ~ ~,~ation for chanae of zonlna mao desl~naUon or change to the City's Future [and Use V, SXGNATURE UNDER OATH: ON OCTOBER Is'r OF, EACH YEAR, EACH LOBBY/ST SHAU. sUBMiT TO THE Cz [Y CLERK A SIGNED STATEMENT UNDER OATH, I/ST~NG LOBBY/NG EXPEND/TURES IN THE CI"TY OF H/AM! BEACH FOR THE PRECEDING CALENDAR YEA~ ! do solemnly swear that all of the foregoing facts are true and correct and that ! have read or am f~miliar with the provisions contained In ~ 2-482 of the Hiami Beach City Code as amended, and a reporting requirements. _ ,~ // . Signature of Lobbyist: ~ ~ · Thomas W. Graboski S,~~t:- -~'' ~t1~ - Jeffrey B erkowitz V~. LOBSYL~' JDF..~ ~ zI-I, CAT/ON: - / J n Produced ~D , Personally Known Form of ~denUficatlon V'~. S~6NAI~RE AND STAI~P OF NOTARY OR DEPUTy CLERK: State of Rodda, County of Miami-Dade Sworn to and subscribed before me . This ~(~ day of ..TA~J ~natu~5~~ Florida Print, stamp or type name of Notary Public FOR r~ mU('S USE ONLY 2nd R~on 3/18/03 F:\CLER\HATL\Lobbyist:s\registrationa 03.doc