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Robert Fine/Fisher Island Holdings, Inc.~ ~~ ~~~ ~~ z~us 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 tf~e 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. FINE ROBERT S. 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) 305-579-0826; 305-961-5826; finer@gtlaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Fisher Island Holdings, LLC NAME OF PRINCIPAL/CLIENT: One Fisher Island Drive Fisher Island, FL 33109 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code) (305) 938-2944 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this sedion if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] . NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Robert Sosa, President • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Floodplain Management appeal and other administrative appeals regarding Palazzo del Sol and del Luna Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship Board of Adjustment Design Review Board, Planning Board ~.~~ ~ a~ s.~?~:~~a ,~~. City Commission ~ ~ ~~ ~ ~Z ~ IV. DISCLOSURE OF TERMS AND AMOUN7S OF LOBBYIST COMPENSATION (DISCLOSE WHETHER NOURLY, FLATRA7FOR OTHERJ: A) LOBBYIST DISCLOSURE: (Required) $495/per hour B) PRINCIPAL'S DISCLOSURE (OF LOSBYIST COMPENSATION): (Requ~red). $4951qer hour ~~'"`°~ ~~ ~ ~~~ ~ :~ ~ ~ ~ I ~ ~ rn ~ The following information must be answered: 1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contribufions By Lobbyists On Procurement Issues": 0 Yes dNo: Are vou lobbvina on a uresent or nendina bid for aoods, eauinment or services, or on a r uresent or oendina award for aoods, eauinment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": oYes ~No: Are you lobbyina on a nendina ap IR ica~ion for a Develo~ment Aareement with the Citv or annlication for change of zoning map designation or chanae to the Citv's Future Land Use Ma°? 3) Pursuant to Miami Beach City Code 2-484 (h) Any person {except those exempt from the deflnition of "lobby'ist" as set forth in Section 2-481 above) who oniy appea~s as a representative of a not-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 cierk as required by this section but, shali not be required to pay any registration fees.. V. SI6NATURE UNDER OATH: ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHAIL SUBMIT TO THE CITI( CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITtJRES, AS WELL AS COMPENSATION RECENED, IN THE CTiY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDI~RES ~R"QOMPENSATI G THE REPORTING PERIOD. ` \ ( / \ \../ ~`-~.~~ ~ Signature of Lobbyist I do solemniy swear tfiat all of the foregoing facts are familiar with the provisions contained in Section 2-482 c requirements. ~ , Signature of Lobbyist: ~ Signature of Principal/Client: ~ VI. LOBBYIST IDENTIFICATION: ^ Produced ID Form of Identification ~,Personally known (Lobbyistj VII. SIGNATURE AND STAMP OF NOTARY: State o Florida, County of Miami-Dade Swo a subscri befo e Th' day o 20~ gn~ft4lre of'Public Not3ry- State of Fiorida Not~agization of LobbyisYs signature and correct and that I have read or am Miarry'..BeaLfi"'Ci }f i C e d all reporting PRINCIPAL IDENTIFICATION: D Produced ID Form of Identiflcation ~~,1,~, ~,R~c~A~ ~ ~~A ~Personaily known (Principal) ~ ~~e~tte F. Colonnese Commission #~DD725232 ~~~~ ». P~s: dAN. 25, 2012 ~ T~so arr.~r-rtc aurwnrc ca. nw~ State of Florida, County of Miami-Dade Swor a subscrib before me J This ~~ of 20 d O Signature o ubiic Notary - Sta f Fiorida Notarization of Principai's signature FOR CLERK'S USE ONLY Annual Registration fee: [ ] Yes [ ] No Amount Paid MCR # Date Paid Lobbyist Registrataon Form received and verified by: F:\CLER\$ALL\MARIA-M\Lobbyist~LOBBYIST fORM 05.doc Revised 12/08/04