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Perry M. Adair/Commerce Bank .(9 'MIAMI BEACH 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 enc.ourage the passage, defeat or modification of any ordinance, resolution, action or decision of any c.ommlssloneri any action, decision, recommendation of the aty Manager or any city board or c.ommltteei or any action, decision or recommendation of any dty personnel during the time period of the entire dedslon-maklng process on such action, dedsion or rec.ommendatlon that foreseeably will be heard or reviewed by the city commission, or a dty board or oommlttee. The term specifically Indudes the prlndpal as well as any employee engaged In lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. Adair Perry M. NAME OF LOBBYIST: (~st) (First) Becker & Pollakoff, P. A., 121 Alhambra Plaza, 10th Floor, Coral Gables, Florida (M.I) 33134 (Zip Code) BUSINESS NAME AND ADDRESS 305-260-1016 TELEPHONE NUMBER: (Number and Street) (atv) (State) 305- 442-2232 FAX NUMBER: padair@becker-pollakoff.com EMAlL: I. LOBBYIST"RETAINED BY: Commerce Bank,N.A. NAME OF PRINCIPAl/ClIENT: Commerce Bank, N.A. 1701 Route 70 East, Cherry Hill. N.J. 08034 BUSINESS NAME AND ADDRESS 856-874-2466 (Number and Street) (aty) (State) (Zip Code) TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section If principal Is a Corporation, Partnel'llhlp or Trust [Section 2-482 (c)) . NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: John Tollomer . IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUSf: Commerce Bank, N.A.ls a wholly owned subsidiary of Commerce Bank Corp., a publicly traded corp. II. SPECIFIC:LOBBY ISSUE: All Issues regEirdln~Commerce Bank's development of property located at 835-855 Alton Road, Miami Beach, FL Issue to be lobbied (oestrlbe In detail): Ill. CJTY AGENCJES/INDMDUALS TO BE LOBBIED: (") '" A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relatlonsmp 0 ::0 n c-) rn c1 ill Please see attached list. None. t"T1 ~ ;;0 ;:;1.:; U1 en ~ 0 .." C'"') I\) rn 0\ < rn o IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y, FLAT RATE 011 OTHER): Hourly, at $350.00 per hour. A) LOBBYIST DISCLOSURE: (ReqUired) B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). Hourly at $350.00 per hour. 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 Yes I2\. No: Are YOU lobbyinG on a Dresent ar oendina bid for aoods. eGulDment or services. or on II Dresent or oendina award for GOods. eGulDment or service? 2) Pursuant to Miami Beach City COde 2.490 Entitled "Prohibited CampaIgn Contributions By LobbyIsts On Real Estate Development Issues": DYes B Na: ArEi'"ou lobbyinG on a DendlnG aDDlication far a DeveloDment AGreement with the City or aDDllcatlon for chanGe of zoninG maD deslGnatian or chanGe to the City's Future Land Use Mu1 . 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-proflt 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 ~ No: Are you reDresentinG a not-fa....Droflt corDOratlon or entity without sDeclal comoen.atlon 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, USTING LOBBYING EXP DITU AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR TH R CE CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO PE 5 OR COMPENSATION DURING THE REPORTING PEIUOD. o Produced 10 9 facts are true and correct and that I have read or am ctlon 2-482 of the MiamI Beach City Code and all reporting I do solemnly swear that all of t familiar with the provisions con In requirements. Signature of Lobbyist: Signature of Prlnclpal/Clle t: , VI. LOBBYIST IDENnFICAnON: Form of IdentifIcation f Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: Form of Identification o i 'II'. 221)' ilij ~ [J Produced 10 [l Personally known (Principal) ATTACHMENT TO LOBBYIST REGISTRATION FORM FOR COMMERCE BANK, N.A. III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Mayor David Dermer Commissioner Matti Herrera Bower Commissioner Simon Cruz Commissioner Luis R. Garcia, Jr. Vice-Mayor Saul Gross Commissioner Jerry Libbin Commissioner Richard Steinberg Design Review Board Historic Preservation Board Board of Adjustment City of Miami Beach Planning Department MIA_DB: C08879/I06220:973660_1]ADAIR