Lucia Dougherty /BR Villa Vuisa
Miami BAch
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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 commissioner; any action, decision, recommendation of the
City Manager or any city board or 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 term "Lobbyists" has specific exclusions. Please refer
to Ordinance 2004-3435.
Dougherty Lucia A.
NAME OF LOBBYIST: (Last) (First) (M.!)
1221 Brickell Avenue Miami Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-579-0603 305-961-5603 doughertyl@gtlaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
BR VILLA VUISA LLC
NAME OF PRINCIPAL/CLIENT:
BUSINESS NAME AND ADDRESS
3110 NE 2ND AVENUE MIAMI
(Number and Street) (City)
FLORIDA
(State)
33133
(Zip Code)
305-757-0001
TELEPHONE NUMBER:
305-757-0017
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:
MICHAEL SAMUEL
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
SOUTH OF FIFTH LLC, BR VL HOLDINGS LLC & OCEAN DRIVE LLC
II. SPECIFIC LOBBY ISSUE:
VARIANCES
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
Planning and Zoning Department
City Commission
Board of Adjustment
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSAnON (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
Al LOBBYI~ DISCLOSURE: (Required) $465.00 HOURLY
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $465.00 HOURLY
1)
vesS
2)
ves6
v.
Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Campaign Rnance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
;~:;~;;;;;:;;:eauimnem~~~ona~
Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach Citv Code Chapter 2. Article VII Division 5
thereof Entitled "Campaign Rnance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Campaign Contributions BY Lobbyists On Real Estate Development Issues":
~you~n~:n a ~dl: aDDl~=-a De~~~ent~ the~~or
aDUlation for chanae of zonina maD desiGnation or chanae to the CitY's Future Land Use MaD?
SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE cnv CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSAnON
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDrru~PENSAnON DURING THE
REPORnNG PERIOD.
Sig re of Lobbyist
I do solemnly swear that aU of the fOf1 oing facts are true and correct and that I have read or am
familiar with the provisions con 'ned in Section 2-482 of iami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
PRlNCIPALIDE~FICAnON:
VI. LOBBYIST IDENnFICAnON:
l' Produced ID .,-;:::.0
Form of Identification
~Iy known (Princi"~
l' Produced ID
Form of Identification
l' ,Personally known {Lobbyist)
YD. SIGNATURE AND STAMP OF NOTARY:
State of Rorida, County of Miami-Dade
Sworn and subscribed before me
This 010..... day ~ S ,2: 'f
Signature of Public No ry - State of Florida
Notarization of Prindpal's signature
State of Florida, County of Miami-Dade
Sworn to~d subscribed before me
This of' 20 Q'\
~ FOR CLE
Annual Rewstration fee: [ ] Yes [ ] No Amou id
Lobbyist Registration Form received and verified by:
Revised 02{10/04 F: L
, a\. Maria-Jose Lopez
!~ · My Commission 00373825
\.~f4'" ExpIres December 03. 2008
.,,~,
-ANNmE J SANGSTER
NOfARY PUBUC Sf ATE OF FLORIDA
COMMISSION NO. 00110259
MY COMMISSION EXP. APR. 21,2006
ON;~ # 2 7 3 aJ0 Date Paid 12- et-I -o~
\MARJA-M\LOBBYI5T\LOBBYIST FORM 04
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y.
FLA T RA TE OR OTHER): ,
A) LOBBYI~ DISCLOSURE: (Required)
B) .PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
o v_t':::ii.: :~~ ~b'::i:~ :n~~p~:t or Dendin~ Ilijl for 90005,. eouipment or services. or on a
~ Dre~nt or DendmG award for Goods. eGUIDment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of a not-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the clerk as required by this
ction but, shall not be required to pay any registration fees..
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL 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 TH PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO E ENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD.
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:
VI.
LOBBYIST IDENnFICATION:
PRINCIPAL IDENTIFICAnON:
[] Produced ID
[] Produced ID
Form of Identification
Form of Identification
[] Personally known (Lobbyist)
[] Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of . 20_
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This _day of , 20_
Signature of Public Notary - State of Florida
Notarization of Lobbyist's signature
Signature of Public Notary - State of Florida
Notarization of Principal's signature
FOR CLERK'S USE ONLY
Annual Registration fee: [ ] Yes [ ] No Amount Paid MCR #
lobbyist Registration Form received and verified by:
F: \ClER\$All \MARIA-M\lobbyist\LOBBYIST fORM OS.doc
Date Paid
Revised 12/08/04