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Lucia Dougherty/Longkey, LLCh1i.~mi fl- ;rh ~~ ~! ~ 1 ~Ul~. ~~ 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 OMinance 2004-3435. Dougherty Lucia A. NAME OF LOBBYIST: (Last) (First) (M.I) Greenberg Traurig 1221 Brickell Avenue, Miami FL 33131. BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-579-0603 305-961-5603 doughertyl@gtlaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Longkey, LLC NAME OF PRINCIPAL/CLIENT: 230 Park Avenue Suite 864 New York NY 10169 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code) 212-342-7300 212-342-7342 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: Sergio Fernandez • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Same as above II. SPECIFIC LOBBY ISSUE: Approval of Variances off setback Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title Planning Department /City Commission BOA Approvals B) Any Financial, Familial or Professional Relationship ZBA IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHERf $550.00 hourly B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 5 5 0 . 0 0 hourly 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": ~ cps ~ No• Are you lobbving on a Dresent or cendina bid for goods eauiument or services or on a Dresent or cendina award for goods eaui~ment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": DYes ~No• Are you lobbvina on a cendina aDOlication for a Develoument Agreement with the Citv or a~~i~~~tion for change of zoning maD designation or change to the Citv's Future land Use Ma°? A) LOBBYIST DISCLOSURE: (Required) 3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of "IobbyisY' 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 [~No• Are you representing anot-for-profit corDOration or entity without special comcensation 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 CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COy1~NSATION DURING THE REPORTING PERIOD. Signature of I u, ~ N LL ~ o ~, c-.t U; j G ~; ~ r~ `r. V -~ '~~ C) a ~ ~ ,, i ~ ~ i~: ~~` ~ ~'~Q J a-° awa StPb I do solemnly swear that all familiar with the provisions c requirements. Signature of Lobbyist: of the foregoing facts are true and correct and that I have read or am mtain~t), in Section 2-482 of the Miami Beach City Code and all reporting Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: Produced ID Form of Identification Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed before me This 2'53 da ~1~ 20 07 i•g re of - of Florida arization of Lobbyi 's signature PRINCIPAL IDENTIFICATION: `~ ~ ~j "'~ ~~ educed ID~I Df ~:S,S ~ ~ Si 33yCI~~ Form of Identification ~~ • a ~- Personally known (Principal) F~ ~ ~ U ~~a6 Q +~ T ii State of Florida, County of Miami-Dade ~ '~ ~ - Sworryapd~scrib before m This _ day of 0~7 Signature of Public Notary -State of Florida Notarization of Principal's signature FOR CLERK'S USE ONLY ` - Annual Registration fee: [ i~es [ ] No Amoun aid ~ MCR # ~ ~ 1 ~ Date Paid Lobbyist Registration Form received and verified by: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc GSA Revised 12/08/04