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Herbert Martin/Seth Gadinsky~ MIAMIBEACH 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. Martin Herbert L. NAME OF LOBBYIST: (Last) (First) (M.I) Dixie Landscape Inc. 12950 NW 113°i Court Medley Florida 33178 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) X305) 884-5700 1305 884-8843 hlmartinC~dixielandscape.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Seth Gadinsky NAME OF PRINCIPAL/CLIENT: 1680 Michigan Avenue Suite 1001 Miami Beach Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (786) 276-2387 (305) 675-7759 SethCo~Gadinskvrealestate.com TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 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: Certificate of Appropriateness/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 Planning and Zoning Department Staff, HPB, BOA, City None Commission IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHERf A) LOBBYIST DISCLOSURE: (Required) $ 75 .00 per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ ~IS 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": ^ Yes X No• Are you lobbving on a present or pending bid for goods equipment or services, or on a present or pending award for goods, equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled'~Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^Yes X No• Are you lobbving on a sending application for a Development Agreement with the Ciri or application for change of zoning map designation or change to the Citv'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 anot-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 X No• Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECENED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITU E OR O P ON DURING THE REPORTING PERIOD. (~~ / Sigh~'ture 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 containep~ Sectio 2 of the Miami Beach City Code and all reporting requirements. ( ~ / ~ ~-H--t- Signature of Lobbyist: _I(l 1J'(~~[/Vl Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: ^ Produced ID Form of Identification ia~Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification ^ Personally known (Principal) State of Florida, County of Miam~e~ 1~, pti-B~L~3L;,,-~ UT ~I,UP11te of Florida, County of Miami-Dade Sworn to and subscribed before I worn and subscribed before me Tara ~cElveen TThh This ~- y of VL Commission #DD395095is day of , 20_ ---,._ Expires: FEB. 10, 2009 antic tigndng Co., I Signat b is Notary - Sta e o on a signature of Public Notary -State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature FOR CLERK'S SE ONLY - Annual Registration fee: ]Yes [ ] No Amount Paid ,~ 1S~ MCR # ~~ l,'~~) Date Paid O ~ } Lobbyist Registration Form received and verified by: Entered By: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYISr fORM OS.doc Revised 12/08/04 J ~ . 1"LKT-' 7 ~~l IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOdRLY, FLAT RATE OR OTHERt A) LOBBYIST DISCLOSURE: {Required) # 7S d0 oer hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $75.00 oer hour The folbwing informatwn must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": 0 Yes X No• Are you iobbvina on a present or pending bid for goods equipment or services or on a present or pending award for goods. equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^Yes X No Are you iobbvina on a pending application for a Development Agreement frith the City or BPpl~tion for chance of zoning map des"uttr anon or change to ifie G"etv's Future Land Use Maps 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 snot-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 X No• Are you representing a notfor-profit corporation or entFty without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CZfY CLERK A 5IGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF ML1MI 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 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 IDENTIFICATION: PRINCIPAL IDENTIFICATION: ^ Produced ID ^ Produced ID Form of Identification ^ Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Swom to and subscribed before me This day of , 20_ Signature of Public Notary -State of Florida Notarization of Lobbyist's signature Form of Identification er5onalty known (Principal) '~*,~ Marc Halpern A ~ My Commission DD301034 F,.oR ~xoires March 29, 2008 State of Florida, County of Miami-Dade Sworn and subscribed fore me This Z3 day t 20~'> ~L Signature 6f Public No~ry -State of Florida Notarization of Priin pal's signature FOR CLERK'5 U5E ONLY c~ ,, Annual Registration fee: [`~ ]Yes [ ] No Amount Paid .T '~ CQ MCR # ~ I Date Paid