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Alfredo J. Gonzalez/Thomas Harris " _s_ , 2lIIl, lD - - 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 modiflcatlon 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, declslon or recommendation of any city 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 foreseeably will be heard or reviewed by the city commission, or a dty board or committee. The term specifically Indudes the principal as well as any employee engaged in lobbying activities. The term ftLobbylstsW has specific exciuslons. Please refer to Ordinance 2004-3435. Gonzalez Alfredo J. NAME OF LOBBYIST: (Last) (First) (M.!) 1221 Brickell Avenue Miami Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-579-0588 305-961-5588 gonzalezaj@gtlaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Thomas Harris NAME OF PRINCIPAljCUENT: 5900 N. Bay Road Miami Beach Florida 33140 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 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: IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Street Vacate of 59th and N. Bay Road Issue to be lobbied (Describe In detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship City Administration City Comission Mayor IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $250.00 HOURLY B) PRlNaPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $250.00 HOURLY Yes (iji) Are YOU reoresentino a not-for-orofit corooration or entity without sDeCial comoensation or reimbursement. Pursuant to Ordinance No. 2004-3435. 1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City 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": 2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach City Code Chaoter 2. Article VII Division 5 thereof Entitled "Camoaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited Camoaian Contributions BY Lobbvists On Real Estate Development Issues": V. SIGNATURE UNDER OATH: ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, USTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE P CEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXP DITU S COMPENSATION DURING THE REPORTING PERIOD. and that I have read or am ach City Code and all reporting I do solemnly swear that all of the foregoing facts are u an familiar with the provision C nta' in Section 2-482 of the MI requirements. Signature of Lobbyis : VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Form of Identification t6roduced ID Fl 0. L . Form of Identification o Produced ID 'j( Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: o Personally known (Principal) State of Florida, County of Miami-Dade Sworn to and subscribed before me This , \ day of 200'-\ State of Aorida, County of Miami-Dade swom~d SUbSCri~ me This day of . 2l1Q-( ~.0~ Signature of Public Notary - S ~IOrida Notarization of Principal's signature FOR Annual Registration fee: [ ] Yes [ ] No Amoun Lobbyist Registration Form received and verified by: Revised 02/10/04 F. CLER ROCIO AOIlRlGlEZ MY COMMISSION' DO 209444 EXPIRES; May 5, 2007 BondedThNNoIIlyP1illk:U_ ON;~#d 1;2-rL('~tepald /L{,-z/uf