Lucia Dougherty/6000 Indn Crk 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 term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
DOUGHERTY
NAME OF LOBBYIST:
GREENBERG TRAURIG, P.A.
BUSINESS NAME AND ADDRESS
305-579-0500
TELEPHONE NUMBER:
(Last)
(Number and Street) (City)
305-579-0717
FAX NUMBER:
LUCIA A.
(First) (M.I)
(State) (Zip Code)
DOUGH ERTYL@GTLAW. COI~
EMAIL:
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
6(~:)0 Indian Creek Drive, LLC
BUSINESS NAME AND ADDRESS (Number and Street) (City)
BSG Development Corporation/Charles Sieger 5996 SW 70 Street~
"'TELEPHONE NUMBER: FAX NUMBER: (Optional)
13th March 06
(State) (Zip Code)
South Miami FL
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:
Acquisition at 6000 Indian Creek Drive
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
City Commission and all boards
B) Any Financial, Familial or Professional Relationship
ZV. DZSCLOSURE OF TERHS AND AHOUNTS OF LOBBYZST COMPENSATZON (DZSCLOSE WHETHER HOUR£~
FLA T RA TE OR OTffER~.
A) LOBBY[ST DISCLOSURE: (Required) $500.00
B) PRZNCIPAL'S DISCLOSURE (OF LOBBY[ST COMPENSATION): (Required). $§00.00
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":
[] Yes o: Are you Iobbvina on a present or ~endina bid for aoods, eouiDment or services, or on a ~ oresent or ~endina award for aoods, eauioment or service?
2) Pursuant to Miami BeaCh City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
~state Development Issues":
DYes ~ No: Are you Iobbvina on a ~endina aoolication for a Develooment Aqreem~nt with th~ City or
a~lication for chan~e of zonin~ mao designation or chan~e to the City's Future Land U~e
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 representaUve 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..
/
[] Yes ~'No: Are you reDresentin,q a not-for-profit corporation or entity without special compensation
I~ or reimbursement..
V. SZGNATURE UNDER OATH:
ON OCTOBER ;~sr OF EACH YEAR~ EACH LOBBYIST SHALL SUBMIT TO THE CZTY CLERK A SIGNED
STATEMENT UNDER OATH~ LIST~NG LOBBYING EXPENDITURES, AS WELL AS COMPENSATZON
RECE]VED~ iN THE CZTY OF M~,MI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN iF THERE HAVE BEEN NO EXPENDZTURES OR COld'SAT]ON DUR]NG THE
REPORTING PER]OD.
Signa~e of L~'bbyi~-"~
LUCIA A. DOUGHERTY
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 Ci~de and all reporting
requirements,
Signature of Lobbyist:
Signature of Principal/Client:
V[. LOBBYZST ZDENTIFZCATLON:
PR[NCZPAL ZDENTZFZCATLON:
[] Produced ID
P~~erson~ Form of Identification
Ily known (Lobbyist)
[] Produced ID
Form of Identification
[] Personally known (Principal)
SIGNATURE AND STAMP OF NOTARY:
State )f~:lorida, County of Mia~l~ade State of Florida, County of MJami-Dade
Swo~ t~ a~d subscribed befofe,fne Sworn and subscribed before me
N ~'re of Pt/bli~ Notary ' State of Florida Signature of Public Notary - State of Florida
ization of Lobbyist's signature Notarization of Principal's signature
Annual Registration fee: [~j~Yes [ ] NO ^/~0unt P~~ MCR #~ _~ ~- ate Paid ,
Lobbyist Registration Form received and veri~'-~ v --
F:\CLER\$ALL\MARZA-H\Lobbyist\LOBBY[ST Revised 12/08/04
IV. DZSCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DZSCLOSE WHETHER HOURI Y~
FLA T RA TE OR OTHER,):.
A) LOBBYIST DISCLOSURE: (Required) $500.00
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $500.00
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":
Yes [] No: Are you Iobbyinq on a present or pending bid for qoods, eauiDment or services, or on a
pre~nt pr pendino award for ooods, eauiDment or service?
2)
Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes [~ NO: Ar~ you Iobbvinq on a aendinq aDDlication for a DeveloDment Aqreement with the City or
application for chanqe of zoninq map desi.qnation or chanqe to the City's Future Land Use
Hap?
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..
[] Yes [] No: Are you reDresentino a not-for-Drofit corporation or entity without special comaensation
or reimbursement..
V. SZGNATURE UNDER OATH:
ON OCTOBER Isz OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SZGNED
STATEMENT UNDER OATH, LZSTING 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 COMPENSATION DURING THE
REPORTING PERIOD.
Signature of Lobbyist
LUCIA A. DOUGHERTY
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:
VZ. LOBBYIST ZDE~~ON: P~N~PAL ZDEN~~ON:
[] Produced ID
Form of IdenUficaUon
[] Personally known (Lobbyist)
[] Produced ID
Form of IdenUficaUon
~Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This 13th day of March _, 20._06
Signature of Public Notary - State of Florida
Notarization of Eobbyist's signature
State of Flodda, County of Miami-Dade ~o_~'~ va~ C. Blanm
Swom and subscrilzecl,before me 2~.% ~~ ~211527
This I'~ day or Y[~Jq, 20~.~ ~~2.~7
Signatu~ o~P~bl~c No~w ~ S~te of Flodda
No~riz~on of Princi~l'~ signature
/~" FOR CLERK'~JS~F~ONLY
Annual Registration fee: (.,,,,'~Yes [ ] No Amo.untZ~cl _~_.~.~ ,~ ~/ MCR ~----~*~(~
Lobbyist Registration Form received and vedfied by:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.d~oc
Revised 12108104