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Clifford Schulman/Fisher Island Holdings, Inc.n~h~„i e~~~n ~ ~~~ ~ ~ r"'...:..~.~. ~ ~u~ 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 dty board or rnmmittee. 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. Schulman, Clifford A. NAME OF LOBBYIST: (Last) (First) (M.I) Greenberg Traurig, P.A., 1221 Brickell Avenue, Miami, Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-579-0613 305-961-5613 schulmanc@gtlaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Fisher Island Holdings, LLC NAME OF PRINCIPAUCLIENT: One Fisher Island Drive, Miami Beach, Florida 33109 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code) 305-938-2944 TELEPNONE 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: 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 City Commission , . ._ , , . 1 ~ A~~ ~ ~ /°1 I .~ ~ ,~ ~f IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHERr B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $620/hOUf 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 ~7 No Are vou lobbvina on a oresent or uendina bid for aoods eauiument or services or on a present or uendina award for qoods eaui~ment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled ~~Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^Yes ~7 No• Are vou lobbvina on a uendin4 annlication for a Develo~ment Aareement with the Citv or aaplication for chanae of zonina ma~ desianation 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 definition of '~lobbyist" as set forth in Section 2-481 above) who only appears 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 clerk as required by this section but, shall not be required to pay any registration fees.. ^ Yes ~ No• Are vou representina a not-for-~rofit corooration or entitv without suecial comnensation 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 RECENED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALEN YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITU~ES n CS~I~NSATION DURING THE REPORTING PERIOD. .~ / 1 / / V ~ign~turEof Lobbyist I do solemnly swear that all of the forego' g facts are true and correct and that I have read or am familiar with the provisions contained in ion 82 the Miami Beach City Code and all reporting requirements. ~ A m ~ ~ ~ Signature of Lobbyist: " i a Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: ^ Produced ID Form of Identification ~ •~wo~ ersonally known (Lobbyist) "" VII. SIGNATURE AND STAMP OF NOTARY: ?~~.~ A) LOBBYIST DISCLOSURE:(Required) $620/hour ~~~~ ;~ ~ -v a :~~ ~ ~ S. ~ ~ State of Florida, County of Miami-Dade Sworn and subscrib~d before me This day of ~~ , /J , 20D8 of Pub~ic Notary - State of Fiorida :ion of LobbyisYs signature PRINCIPALIDENTIFICATION: ^ Produced ID Form of Identification ~Personally known (Principal) NOT ~ARY PUBLIC~'!'ATE OF FLORIDA "'~ Cath~rine F Colonnese ~ Commiasion ~ DD725232 State of Florida, County of Miami-Dade ~~~p~. J~_ ~~ ~~L Sworn r,~,i subscribed before me ~~~~~~~a~~~ This ~` y of~J 2 ~~ Signature of Public Notary ate of Florida Notarization of Principal's signature FOR CLERK'S USE ONLY Annual Registration fee: [ ] Yes [ ] No Amount Paid MCR # Date Paid Lobbyist Registration Form received and verified by: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc Revised 12/08/04