Affidavit
,NT -BY: Bl;ACOW & RADELL PA'
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. .
3053776222'
,
JAN.f9,Of
4:37PMj PAGE 3/4
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CITY OF MIAMI BEACdl J"~I '. I ,/ E"D
OFFICE OF THE CITY C~' 30."
1700~CentefDffle' 'i;", 'il/IO:/,
MIamI Beach, R. 33139 ~'J Il( '0'.. ;:
~tyde~.mlaml.beach.".us ["fICE'
AfflDAVIT
.
I08IMST MEANS AlL PERSoNS EMPLOYeD OR RETAINED, WHETHeR PAID OR NOT, BY A PlUNOl'AL WHO SEEKS
TO eNCOURAGE THe PASSAGl:, DEFEAT OR MODIFICATION OF ANY ORDINANCe, RESOlUTlOH, ACnON OR
DEOSION OF ANY COMMISSIONER; ~y ACTION, DECISION, RECOMMENDATION OF ~y CITY IlOAAO OR
COMMmEE; OR ANY ACTION, OEOSION OR RECOMMENDATION OF ~y PERSONNEL DEFlHED IN ANY MANNBl
IN THIS SECOON, DURING THE TIM!! PERIOD OF THE ENTIRE OEOSION-I'lAKIHG PROCESS ON SUCH ACTION,
OEOSION OR RECOMMENDATION THAT FORESEEAlll Y Will BE HEARD OR R.EVIEWED Ill' THE erN COMMISSION,
OR A CITY SOARD OR COMMITTEE. THE TERM SPEClFJCAll y tNCl.Uoes THE PlUNOPAl AS WELL AS ANY AGENT,
ATTORNEY, OFFICER OR EMPLOYEE OF A PRlNOPAl., REGARDlESS OF WHETHER SUCH LOBBYING ACI1vmES
FAlL WITHIN THE NORMAL SCOPE OF EMPLOYMENT OF SUCH AGENT. ATTOANEY, OFfiCER OR EMPlOYEE. EACH
PERSON WHO WITHDRAWS AS A lO88YIST IS REQUIRED TO fiLE A "CERTIFICATE OF WITHDRAWAL."
1) Lobbyist Name: Gallo William
Last Name First Name
J.
Middle initial
BusIness Phone Wj 480- 2800
BUSiness Address: 1 31 1 Newport
No.
Deerfield Beach
City
Emall Address:
2) Prindpal Retained by:
Walgreen Company 200 WHmont Road MS 2252
If different from above SIJ eet Suite
Deerfield Illinois 60015
Oty St..te Zip Code
(a) ,If a corporation, partnership, or trust, identify and provide the address for the chief
officer, pllrtner, beneflclary or interests.
Message Phone LJ
Center Drive, west
~reet
Florida
state
33442
Zip Code
Suite
3) Subject Matter (Describe in Detail): DeSiqn Review Soard Aooroval
4. Identify each indiYldual (Commissioners, Soard, Committee, Authority member or Oty staff)
to be lobbied: Oesion ReView Board __
seNT BY~. BERCaw & RADELL PAt
, ,
3053776222;
JAN-19-01 4:38PM;
PAGE 4/4
'.
5. The subject matter in number three (3) ab~ve Is to be considered at the meeting of
(Identify each entity or individual):
o The Oty Commission
o City CommiSSion Subcommittee
tI City Staff
8 City Board or Committee Desian R~view Board
o Personnel
c Identify Others
.2000
.2000
.2000
20 , 2000 .
.2000 '
2000 .,
,
OIl
on
on
on March
on
on
6. State the extent of any bUsIness, financial, familial, professional or other relationship which
exists with any Individual identified In number (el) above:
ON JUt. Y 151 0" EACH YEAR, EACH LOBBYST SHALL SUBMIT TO THE CITY CLERK A
SIGNED STATEMENT UNDER OATH, USTING A LOBBYING EXPENDITUR!S IN THE
CITY OF MIAMI BEACH FOR THE PRECEOING CALENDAR YfAR.
I do solemnly swear that all of tJle 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 Oty Code as
amended. and all reporting requi '.. .
SIgnature of lobbyist:
p( Personally known
o Produced W
'~~.
. '.
Identify
.'
I,
o Did take an oath, or
o Did not take an oath
If Notary.
fOR CleIUt'S use ONLY
Registration: [) ACCEPTED (] RfJECfEO DATE:
State of Florida. County of Miami-Dade
Sworn to and SUbscrl~ before me A.J.
This a"l day of I <\,;\lfj-J 211U\"
If rejected, stICe reason:
Rcgistratlon ,.. paid: [ ) Yes ( J No () Ncll-ror-rmtIt Orga.o/zaaQn
( ) castl { ] Cheo;k MtR ,
. .:'
DATA ENTRY DATE:
. 2000 ENTBlEl> BY:
,
PROJECT:tAitJr/qra~5
(name, addressl
(fJiaM; ;XaJ;
TO: rtJ--<1 of ;1J~; &~ -,
e./ri cr!..~ c/trles tJffl<<:"'" /J
/'l7oti ('0/1 l/eJ;i!o/7 1Je171-t ~ Ur/i{?
ATTN: fJ11(vM i (XClclt ;,;:t;'/ 3313')
WE TRA~SMIT,LllliHfYf If,r/.f;.d .J
(X) herewith () under separate cover via
( ) in accordance with your request
FOR YOUR:
( ) approval
( ) review & comment
w) use
THE FOU[OWING:
( ) Orawings
( ) Specifications
( ) Change Order
GALLO
ARCHITECTS & DEVELOPMENT CONSULTANTS. INC.
AA-()0()2853
~
GAJLJLO. DUBOiS
.If.w.R.
CONSTRUCTION SERVICES, INC.
CGCOJ40JI
TRANSMITTAL
ARCHITECT'S 18,2000 /;/
PROJECT NO: 1 T
DATE:
/-21-()/
If enclosures are not as noted, please
inform us immediately.
If checked below, please:
( ) Acknowledge receipt of enclosures.
( ) Return enclosures to us.
ArtJ;rll ~
) distribution to parties
) record
)
( ) information
( ) Shop Drawing Prints
( ) S~p Drawing Reproducibles
cf.) 1/ocu~,)
) Samples
) Product Literature
COPIES DATE REV. NO. DESCRIPTiON ACTiON
CODE
I 124/0 I C ~ clc- --:t1: /-- \
fSL3 9" }...e-e .5
I 1JJ,1{,'hVt T f;t.((D fLt-H-; Jdri
ACTION A. Action indicated on item transmitted
CODE B. No action required
C. For signature and return to this office
D. For signature and forwarding as noted below under REMARKS
E. See REMARKS below
REMARKS
COPIES TO:
(with enclosures)
o
o
o
o
o
BY:
YA~
" 11 NEWPORT CENTER DRIVE WEST . DEERFlELD BEACH, FLORIDA 33442 . TELEPHONE (954) 480-2800 . FAX (954) 480-2885
~
~~ "'~'.'.~"a""""'."''''''.'''~~'::::,~~;~~~:~~€i~:;';::~::~
~ COLUMBUS,QHI043271
ARCHITECTS a DEVELOPMENT CONSULTANTS. INC. 25-80/440
1311 Newport Center Drive West. Deemeld Beach. Ft. 33442 CHECK NO.
(954) 480.2800
15239
~
15239
'AY ** Fifty and 00/100 Dollars **
DATE
01/29/2001
AMOUNT
**********$50.00
OTHE
RDER
F
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 CONVENTION CENTER DRIVE
MIAMI BEACH, FL 33139
m SECURITY FEATURES INCLUDED. DETAILS ON BACK. m
.
1100 ~s nqllo 1:01.1.000801.1: 01. ~ ~O Sqqql. j811
GALLO ARCWTECTS " DEVELOPMENT CONSULTANTS. INC.
CHECK NO.
15239
Invoice # Type Date
Description
Total Amount
Discount
AFFIDAVIT Inv 01/29/2001 WALGREENS 18-2000
$50.00
$0.00
Check Amount:
$0.00
$50.00
Remittance For:
CITY OF MIAMI BEACH
Totals: $50,00
Date: 01/29/2001
/'
}