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Alfredo Gonzalez/Greenstreet Partners, L.P.m 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. ALFREDO GONZALEZ _ J. NAME OF LOBBYIST: (Last) (First) (M.I) GREENBERG TRAURIG, P.A. 1221 Brickell Avenue, Miami, FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-579-0588 305-961-5588 gonzalezaj@gtlaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Brad Safchik NAME OF PRINCIPAL/CLIENT: Greenstreet Partners, L.P. 2601 S. Bayshore Drive, Suite 800, Coconut Grove, FL 33133 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code) (305)858-4225 (305) 858-2334 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: Jeff Safchik • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Jeff Safchik II. SPECIFIC LOBBY ISSUE: Zoning issues at 1600 Lenox Avenue, Miami, Florida Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title I B) Any Financial, Familial or Professional Relationship Planning and Zoning Department N/A City Commission IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHERf A) LOBBYIST DISCLOSURE: (Required) $345.00 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $345.00 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": 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.. or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER lsT OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPEND TURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PREC DING CALENDAR'YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDI ORES OR COM~NSATION DURING THE REPORTING PERIOD. .~~~ ~ `~ '1 Si nature of Lobbyist _)AL EDO J. GONZALEZ I do solemnly swear that all of the foi-egoin~.fac`~s -are true an correct and that I have read or am familiar with the provisions cgntaine~ in Section 2-482 of the Miami Beach City Code and all reporting requirements. ~ , Signature of Lobbyi Signature of Princip VI. LOBBYIST I[ u Produced ID Form of Identification ZALEZ PRINCIPAL IDENTIFICATION: u Produced ID +Yd'~ s "Or o ~ ~Og~4q . ~~^~C m~~zl x..< ~ o a (7y n~' I~~3" I o ~ r r I N N ~ Q Ia~.v ci 1 N O N Uj Q A O 00 'TI Q: O ~ ~ ~` n ~, Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Swor and subscri befor e Thisday o , 20~~ A Sign a of Public Notary -State of Florida Not ization of Lobbyist's signature Form of Identification NOTARY PUBLIC-STATE OF FLORIDA Personally known (Principal) Georgia Williams Commission # DD456905 Expires: AUG. O1, 2009 Bonded Thru Adandc Bonding Co., Inc. State of Florida, County of Miami-Dade GL'arq~'~` W ~(,l~~tS Sworn nd subscri ed beforeSworn subscri before me 1 This day of /u~St{A1-,n1' 20(~~~ Signature Pu c Notary - St/!a-t1e-K-o_fA.lFlorida Notarization of Principal's signature FOR CLERKS USE ONLY il, Annual Registration fee: ~ ]Yes [ ] No Amou t-p~i~ -'~. MCR # ~~ ~ 1 u ~ ~ Date Paid !~~ ~ ~ ~~ ~ ~ _ ~~ Lobbyist Registration Form received and verified by: ~ L ~:-'" F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05:doc Revised 12/08/04 2) Pursuant to Miami Beach City Code 2-490 Entitled °Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues":