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John Lowell/Codina Realty -.! J C;'- "1mm;~ Ibd!I:d 1P' 1il03 m - 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 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 ftLobbyists" has specific exclusions. Please refer to Ordinance 2004-3435, Lowell John NAME OF LOBBYIST: (Last) (First) Codina Realty Services, Inc. 355 Alhambra Circle, BUSINESS NAME AND ADDRESS (Number and Street) (City) 305-520-2454 TELEPHONE NUMBER: 305-520-2472 FAX NUMBER: Suite 900, Coral (State) jlowell@codina.com EMAIL: (M.!) Gables, (Zip Code) FL 33134 I. LOBBYIST RETAINED BY: Lilian A. Gregory NAME OF PRINCIPAl/CLIENT: N/A BUSINESS NAME AND ADDRESS 88 La Gorce Circle, Miami Beach,FL 33141 (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 SOlo OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II, SPECIFIC LOBBY ISSUE: Application for side yprd setback variance 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 Board of Adjustment None '. IV, DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLA T RA TE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) Codina Realty will be paid a 2% commission for the sale of 86 La Gorce Circle B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). Same 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": DYes UlNo: Are vou lobbYing on a oresent or oending bid for goods, eguioment or services, or on a oresent or oending award for goods. eguioment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": DYes 0 ~o: Are YOU lobbying on a oending aoolication for a Develooment Agreement with the City or aoolication for change of zoning mao designation or change to the City's Future Land Use Mao? 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.. D Yes ~o: Are YOU reoresenting a not-for-orofit corooration or entity without soecial 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 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 COMPENSATIO U NG 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 contained in S . n 2-48 of t I ~fi}i Beach City Code and all reporting requirements, r ~ Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: D Produced ID D Produced ID Form of Identification " Personally known (Lobbyist) Form of Identification 'personallY known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: FO Annual Registration fee: [ ] Yes [ ] No A ou Lobbyist Registration Form received and verified by: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc aLJdEI3JC.'~SE ONMLCYR ,,"'~r 4 r;. C\ ,~ ~~ -01) ~-LL~ Date Paid ',-L nt1" Revised 12/08/04