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Gonzalez Alfredo/Charles Dascal " Miami ~h ""' 2QU! ~ - - 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 dty board or committee; or any action, dedsion or recommendation of any city personnel 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 dty commission, or a city board or committee. The term spedfically includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. Gonzalez Alfredo J NAME OF LOBBYIST: (Last) (Arst) (M.I) Greenberg Traurig 1221 Brickell A venue, Miami FL 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: Charles Dascal NAME OF PRINCIPAL/CUENT: 1500 Daytonia Road Miami Beach Florida 33141 BUSINESS NAME AND ADDRESS (Number and Street) (Oty) (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 BENEFIOARY: . IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: D. SPECIFIC LOBBY ISSUE: Planning Board - Dock Issues Issue to be lobbied (Desaibe in detail): ID. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A} Full Name of Indlvidual/ntle B) Any Financial, Familial or Professional Relationship Planning Department Planning Board Building Department .,. il B! .11 JJS l~J ~.~ \~lt .. IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLA T RA TE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $290.00 Hourly B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $290.00 Hourlv 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": D Yes IX No: Are YOU lobbyina on a present or pending bid for goods, eguipment or services, or on a present or pendina award for aoods. eguipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": DYes IX No: Are YOU lobbying on a oendina application for a Development Aareement with the City or application for change of zonina map desianation or chanae to the City's Future Land Use Map? 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 section but, shall not be required to pay any registration fees.. DYes \XNo: Are vou representing a not-for-profit corporation or entity without special comoensation or reimbursement. 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 ELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDI CAL AR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITU R NSATION DURING THE REPORTING PERIOD. / 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 cont . ed in ection 2-482 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATIO~: o Produced ID NCIPAL IDENTIFICATION: ~. roduced ID ffo. .l:)I\{.r~ IAC01~ C(Q.\ Olf.()"). 5~~ 1 D Form of Identification Form of Identification ~erSOnallY known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: D Personally known (Principal) ~.:'\ ~ f.f~ ~i.I r I. ~I s- ~ State of Florida, Coun swor'}jDP subscr' d This '6 day Ignature of Public Notary - State of Florida Notarization of Lobbyist's signature Signat Public Notary - State of Florida Notarization of Principal's signature FOR CLERK'S USMNL Y Annual Registration fee: D'S Yes [ ] No Amount Paid' 2...,;;s.. MCR # 2::t1aD?i:3 Lobbyist Registration Form received and verified bY~ ~~ F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM c Date Paid 1.1 2.5/or:;; , Revised 12/08/04