Robert Brown/Seth Gadinsky (3)~? MIAMIBEACH
City of Miami Beach Office of the City Cterk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a princpal who seeks to encourage the passage, defeat
or modification of any ordinance, resolution, action or decision of any commissioner; any action, dedsion, 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 deasion-making process on such action, derision or recommendation that foreseeably will be heard or reviewed
by the dty wmmission, or a dty board or committee. The term spedfically includes the principal as well as any employee engaged
in lobbying activities. The berm "Lobbyists' has spedfic exdusions. Please refer bo Ordinance 2004-3435.
Brown Robert
NAME OF LOBBYIST: (Last) (First) (M.I)
Robert Brown Architect 6710 SW 80"' Street, Suite 101 Miami Florida 33143
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 662-1940
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
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 Seth@Gadinskyrealestate.com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
out this section if prindpal is a Corporation, Partnership or Trust
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:
Development approvals for new Walgreens Store at property located at NE corner of Biarritz Drive and 71 Street.
Issue to be lobbied (Describe in detail):
III. CITY AGENQES/INDMDUALS TO BE LOBBIED:
A) Full Name of individual/Titre
Planning and Zoning Departrnent Staff, DRB, BOA, Planning
Board, City Commission
B) Any Fnandal, Familial or Professional Relationship
None
Ti/. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERx
' A) LOBBYIST DISCLOSURE: (Required) $ 125 00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 125 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 lobbying on a present or pending bid for goods eguipment or services or on a
present or pending award for goods, eguipment 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 lobbvina on a cend ni g auulication for a Development Agreement with the City or
gpplication for chance of zoning mac designation or change to the City's Future Land Use
Ma°?
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 speaal 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
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDA YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURE OR M SATION DURING THE
REPORTING PERIOD.
,/- Signature of Lobbyist
I do solemnly swear that all of the oregoing f are true and correct and that I have read or am
familiar with the provisions cont~fin~ in~6ectiq-482 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
o',~•a,,,.,,~~I c
^ Produced ID =~
Form of Identificatio '••.,~,;,:,•'~ •~
Personally known (Lobbyist) ' ~ 5
~5c9c~
v~ y ~ H
VII. SIGNATURE AND STAMP OF NOTA~~ n ~
State of Florida, County of Miami-Dade ~ ~ ~ ~. ~
Swom d subscribed before me ~ ~,, e
This t ~ day of 1.~C~ l~ • . 20 ~ ~ ~ °; ~
9 N r0 fD
tit . r I A .I ~ t A 1''~ ~- ~ ° ~ °' ~
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miami-Dade
Swom and subscribed before me
This day of , 20_
Signature of Public Notary -State of Florida
Signature of Public Notary -State of Florida
Notarization of Lob fist's si nature Notarization of Princi I's si nature
s FOR CLER 'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # ~'`~ ~ Date P `~ ~ ~
Lobbyist Registration Form received and verified by: ~ ~ Entered By:
F:\CLER\~ALL\MARIA-M\Lobbyist\LOBBYLSr fORM OS.doc ~ ~ ~O J2 Revised 12/08/04
I1/. DISCLOSURE OF TERNS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HO(/RLY,
FLAT RATE OR OTHER] /2S ~0 ~rtszu~
A) LOBBYIST DISCL05URE: (Required) # (69.00 pgr hour
~ZS
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ , -466:0 Der hour
the foibwing informatbn must be answered:
i) Pursuant to Miami Beach City Code Section 2-A88 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Devebpment Issues":
QYes X No: Are You bbhvina Q,B a oe a 1)eveionment ~~rnent witl>t tine City or
auoi~l~g~QK ~gE„Q~Ap Itil1!~_o~i>~i1lL the Citv's Future Land Use
Man?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt ftom the definition of
"lobbyist" as set forth in Section 2-481 above) who ony appears as a representative of anot-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether da~ect, or
indirect, to express support of or opposition to any item, shall regi~er with the clerk as required by this
section but, shall not be required to pay any registration fees..
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LI57ING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, ~i THE CITY OF MIAMI 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:
^ Produced ID
Form of Identification
^ Personally known (t.obisyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of . 20_
Signature of Public Pkrtary -State of Forida
Notarization of Lobbyist's Signature
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identificatan
~-Personalty known (Prindpal)
State of Florida, County of Miami-Dade
Sworn and subscr~ fore
This ~~,d/// 1 20~
Signature of Public Rotary -State of Forida
Notarizatbn of Principal's signature
~~
.~
~ S
FOR CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # Date Paid
Lobbyist Registration form received and verified by: Entered By: _ __