Office Depot, Inc.
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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 cDmmissioner; any action, clecision, recommendation of the
City Manager or any city board Dr committee; or any action, decision 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 city board or committee. The term specifically includes the
principal as well as any employee engaged in lobbying activities. The tenn wLobbylsb" has specific exclusions. Please refer
to Ordinance 2004-3435.
Dougherty Lucia A.
NAME OF LOBBYIST: (Last) (First) (M.I)
1221 Brickell Avenue Miami Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (Qty) (State) (Zip Code)
305-579-0603 305-961-5603 doughertyl@gtlaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Office Depot, Inc.
NAME OF PRINOPAL/CUENT:
c/o Nick Roth 2200 Old Gennantown Road
BUSINESS NAME AND ADDRESS (Number and Street)
Delray Beach
(City)
Florida
(State)
33445
(Zip Code)
561-438-0519
TELEPHONE NUMBER:
561-438-0498
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section If principal Is a Corporation, Partnership or Trust [Section 2-482 (e)]
. NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
Edward Costa
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
Publicly Traded
II. SPECIFIC LOBBY ISSUE:
Sign Variance
Issue to be lobbied (Describe in detail):
III. CITY AGENOE5/INDMDUALS TO BE LOBBIED:
A) Full Name of Indlvldual/ntle B) Any Financial, Familial or Professional Relationship
Planning and Zoning Department
City Commission
Board of Adjustment
lV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $465.00 HOURLY
B) PRINOPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $465.00 HOURLY
Yes 6-;\ ~:~~ reDresentinG a not-for-Droflt corooration Dr entitv without sDeClal comoensation or
___u- __ Pursuant to Ordinance No. 2004-3435.
1)
Yes 8
2)
Yes e
v.
Pursuant to Ordinance No. 2003-3393 Arnendino Miami Beach City Code Chaoter 2. Artide 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":
~ v~~ ~b~~~,:~ ~ ~~~~~SI eaulDment or servlces, or on a Dresent
or oendlnG award for Goods. eaulDment or service?
Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach atv Code OlaDter 2. Artide VII Division 5
thereof Entitled "Camoaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoalan Contributions BY Lobbvists On Real Estate Development Issues":
=;:it.::';:~n::':~:e ,,:;:~~:::~:~:=e~::~::::,~c'::~ ~:::~~:VU: MaD?
SIGNATURE UNDER OATH:
ON OCTOBER 1 sr OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING LOBBYING EXPENDnvRES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECED G CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDIT ES 0 COMPENSATION DURI THE
REPORTING PERIOD.
I do solemnly swear that all of the foregoing facts are true ailcl rrect and that I have read or am
familiar with the provisions contained in 'on 2-482 of t Miami Beach City Code a all reporting
requirements.
Signature of LObbyist:
/ Signature of Principal/Client:
VI.
Produced ID
.__----- . Fetm(lfIdentification
C:;:rsonallY known (Lobbyi~)'
VII. SIGNATURE AND STAMP OF NOTARY:
?J IJIoIII M.l.UoM
!'~ . t.IV CCn1friMlon 00201132
~"./;I ~_~24. 2005
FOR
Annual Registration fee: ] Yes [ ] No Amo t
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F:
PRlNOPAL IDENTIFICATION:
Produced ID
State of Florida, County of Miami-Dade
Swom and subscribed before me u
Thi~ayoff\~ilAhtf.200 1
-=
Signature of Public Notary - State of Florida
Notarization of Principal's signature
~1\. ~CJonea
\, '!Ii My Commllllon "0011121
.. '" ElcIIlIee ~ a, 2llOll
ON~~ d 73 ~O I Date Paid I b9- 9" ()
-M\LOBBYISl\LOBBYIST FORM 04