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Groenhoff, Andre/Pathman Lewis M_ Iladl ~" lIIIlIS m - " City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRA nON 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, dedsion, recommendation of the Oty Manager or any dty board or committee; or any action, decision or recommendation of any dty personnel defined in any manner in this section, during the time period of the entire decision-making process on such action, dedsion or recommendation that foreseeably will be heard or reviewed by the dty commission, or a city board or committee, The term specifically includes the principal as well as any employee engaged in lobbying activities, The tenn "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. Groenhoff NAME OF LOBBYIST: (Last) Andre (First) 6500 North Andrews Avenue, Ft. Lauderdale, FL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (M.I) 33309 (Zip Code) (954) 776-1616 TELEPHONE NUMBER: (954) 771-7690 FAX NUMBER: aqroenhoff@keithandschnars.com EMAlL: I, LOBBYIST RETAINED BY: pathman Lewis, LLP / Wayne pathman NAME OF PRINCIPAljCUENT: pathman Lewis, LLP BUSINESS NAME AND ADDRESS (305) 379-2425 TELEPHONE NUMBER: One Biscayne Tower, suite (Number and Street) (City) (305) 379-2420 FAX NUMBER: (Optional) 2400, Miami, FL 33131 (State) (Zip Code) wpathman@pathman1ewis.com EMAlL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] . NAME OF CHIEF OFACER, PARTNER, OR BENEFICIARY: 1ft{..- ~ f'" /$e. J..L6 ,4l1'"J If, A r;1-,lV/IC-j.-/' ,;<-l-o<<-~, \vji tfoU ,-'otl.- - · :/ IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: 1t? lv' ;1 U- p /I- A T/f# p-'y.I> Ie 6eft.-+ ,M, ro T;f--t-t ,\I J .-. . II, SPECIFIC LOBBY ISSUE: -: c;:, -( .4:- ,-, ~ ::tJ ' ) r--- ,.~ f-ry , , ~~ =z-, f'o.J C) ~ -&:- rr] v; ~ -- 5th and Alton at Miami Beach Issue to be lobbied (Desaibe in detail): III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: - - "'~ . ..,.., ~ A) Full Name of Individual/Title B) Any Financial, Familial or Professional Rela@!nshl)E> C"') - IT) - Miami Beach City COJllIl\ission N/A Miami Beach Manager N/A Miami Beach Public Works N/A " . ,. IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLAT RATE OR OTHER): .... , A) LOBBYIST DISCLOSURE: (Required) hourly enqineerinq fees B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required), 1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach Citv Code Chaoter 2. Article VII. Division 5 Thereof Entitled "Camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited Camoaian Contributions BY Lobbvists On Procurement Issues": Yes E) Are YOU lobbYInG on a Dresent or oendlnG bid for Goods. eauiDment or services. or on a Dresent or oencllnG award for Goods. eauiDment or service? 2) Pursuant to Ordinance No, 2003-3395 Amendino Miami Beach Citv Code Chaoter 2, Article VII Division 5 thereof Entitled "Camoaian Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited Camoaian Contributions Bv Lobbvists On Real Estate Develooment Issues": Yes No: Are YOU lobbYinG on a oendlnG aDDllcation for a DeveloDment AGreement with the CitY or aDDlicatlon for chanGe of zoninG maD desiGnation or chanGe to the OtvOs Future Land Use MaD? V. SIGNATURE UNDER OATH: ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST 5HALL 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. ~'~,-./4 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 2-482 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: C, --i VI. LOBBYIST IDENTIFICATION: Produced ID Form of Identification Form of Identification ~rsonally known (Principal) ("-:; r-' rn v'fSersonally known (lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of .Mia",! ead..13t'OWA-l2d Swom to s ' fore me This of Ma 20.2..4 ~ -",. ~> State of Florida, ~unty of Miami;Dade ~ Swom and subscnbed before me .I, ;:: This ~day of ~ 20..D.'t' C") '" ,"'" F-Jh aft fa...:> Signature of Public Notary - State of Florida Notarization of Principal's signature MARlENE PINNOCK MY COMMISSION # DO 287914 EXPIRES: Febl\l8lY 13. ,2008 BondodTh..NoIIJy~~ B. J, VAlDES MY COMMISSION # DO 090119 EXPIRES: February 7, 2006 Bonded Thru Notary Public Undel'Wl'il:ers EONLY . /1 c / /f7~ MCR#0't>1l/1 DatePaid f/r~-UT FOR CLE Annual Registration fee: [ Yes [ ] No Arno n aid Lobbyist Registration Fonn received and verified by: Revised 02/10/04 F: c::;. .c- ~ :::0 ~-!I.. ~ m --: N 0 ./:"' m .:t>a < :J: '-0 m 0 P ATHMAN LEWIS, LLP ATTORNEYS AT LAW WAYNE M. PATHMAN, P.A. HAROLD L. LEWIS, P.A. ROGER SLADE- ALEX KURKIN DAVID E. SACKS MARC C. PUGLIESE LOUIS P. ARCHAMBAULT MARC E. BRANDES ONE BISCAYNE TOWER. SUITE 2400 2 SOUTH BISCAYNE BOULEVARD MIAMI, FLORIDA 33131-1803 TELEPHONE (305) 379-2425 FACSIMILE (305) 379-2420 JEAN MCLEOD, CLA ADMINISTRATOR ;mcleod@pathmanlewis.com 'aJsoaclmiltedtopracticeln New- Yol1l & ConnectictJt May 28, 2004 Ms. El1zabeth Gibson City of Miami Beach City Clerk's office 1700 Convention Center Drive Miami Beach, FL 33141 Dear Elizabeth: Per our conversation today, here is a check for $100 to be applied toward the lobbyist registration fee (along with the $50 check previously sent to you) for Andre Groenhoff, whose application you have. Jose Rodriguez will not be registering at this time. As I mentioned, I will be on vacation, so if you have any questions, please call David Sacks of this office. We very much appreciate your assistance. Very truly yours, Ene. r:\a r sobe\a r sobe - 5th street zoning\ltrs\(-)e. gibson, mb clerk's office-lobbyist reg.doc AN LEWIS, LLP ~