Marbet Mier/Publix Super Markets, Inc.C7 N
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City of Miami Beach Office of the City Clerk u -t,
1700 Convention Center Drive, Miami Beach, FL 33139 0 a :~~!
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LOBBYIST REGISTRATION FORM ~ W
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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 dedsion of any commissioner; any action, decision, recommendation of the
City Manager or any dty board or committee; or any action, decision or recommendation of any dty personnel during the time
period of the entire decision making process on such action, derision or recommendation that foreseeaby will be heard or reviewed
by the city commission, or a dty board or committee. The term speafically indudes the principal as well as any employee engaged
in lobbying activities. The term "Lobbyists" has specific exNusions. Please refer to Ordinance 2004-3435.
Mier Marbet
NAME OF LOBBYIST: (Last) (First) (M.I)
Gra Robinson P.A., 401 E. Las Olas Blvd., Suite 1850
Fr~r~ T.ai~rlPrrla ~ a' F1 nri rla ~ ~'~f11
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
_954.761_7472 954_761_A112 mmi r(d~x_rohincnn nnm
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Publix Super Markets, Inc.
NAME OF PRINCIPAL/CLIENT:
Publix Super Market
3300 Publix Corporation Parkway, Lakeland, Florida 33811
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code)
863.688.7407
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 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
*Please see attached.
II. SPECIFIC LOBBY ISSUE:
Representation in a variance hearing for a distance requirement
fnr hPC~r anc~ wine calc~c fnr riff nrPmicr~ rnnc»m~tinn nnl~
Issue to be lobbied (Describe m detail): ,
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title I B) Any Financial, Familial or Professional Relationship
;,'
Board of Adjustment
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required) 2 / V ~ y~ hourly
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).~~n 1 i . a n t
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 btNo: Are you lobbvina on a present or pending bid for goods eauipment or services or on a
present or pending award for goods eauipment or service
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes ~ No• Are you lobbvina on a pending application for a Development Agreement with the City or
application for change of zoning map designation or chance 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 anot-for-profit
corporation or entity without special rnmpensation 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..
0 Yes ~ No• Are you representing coot-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
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALEND AR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BE~~O EXPENDITURES OR COMp~TION DURING THE
REPORTING PERIOD. ~ \\
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are true n rrect and that I have read or am
familiar with the pro isions contained in Section 2-482 of the i Beach City Code and all reporting
requirements. /)
Signature of Lobbyist: l v Q ""~..
Signature of Principal/Client: l~n~,no p~ '~'Yl. Gt9~~-'~~ UFa nL-(~-or~~l Y'2(1rt~rtla-~
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID
~ Form of Identification
< ~~
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19' Personally known (Lobbyist)
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VII. SIGNATURE AND STAMP OF NOTARY:
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~ State of Florida, County of P
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> °Zj Sworn to and subscribed before me
~ This t ~ day of S~r\~ , 20Q-'j
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~~ Signa a of Pu is otary -State of Florida
~" Nota zation of Lobbyists signa~trre
07firoduced ID fi'ji Vl^i VP.IS La cstia,2_
Form of Identification
^ Personally known (Principal)
2owNn~.~
State of Florida, County of
Sworn amend subscribed before me
This ZL-- da of S~~nG. 20Q1
~~ ~ A ~~
SignAture of ~blic No cry -Stag of Florida
Notarizati n o cipal's signature
Annual Registration fee: [ ]Yes [ ] No A
Lobbyist Registration Form received and verified b
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM
ONLY
MCR # ate Paid
Ownershiu Interest in the Princiual of Publix Sutter Markets, Inc.
Title/Position Name Stock
President William E. Crenshaw 0.33
Vice President/ Charles H. Jenkins, Jr. 0.91
CEO
Secretary John A. Attaway, Jr. 0.00
Treasurer David P. Phillips 0.03
Director(s) Howard M. Jenkins 3.76
Carol Jenkins Barnett 5.74
Stockholders Hoyt R. Barnett 0.72
Advisor to CEO Tina P. Johnson 0.03
Senior VP Robert S. Charlton 0.00
Randall T, Jones 0.00
VP Real Estate John T. Frazier 0.01
Assistant Secretary Sharon A. Miller 0.02
Bar Manager Director of Tax & Treasury 0.00
(Fraternal Organizations of Kelly Underhill
National Scope)