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Robert Sokolove/Fisher Island Holdings, LLCR~xttii Bich r ' .~ x t~ Y Zi(II(i3 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 enrnurage 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 Ordinance 2004-3435. SOKOLOVE ROBERT D., Esq. NAME OF LOBBYIST: (Last) (First) (M.I) Wetland &Floodplain, Consulting Company, 4 Norfolk Street, Rehoboth Beach, DE 19971 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 302-381-8062 302-260-9130 bob@wetlandfloodplain.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) out this section if principal is a Corporation, Partnership or Trust • 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 Board of Adjustment Design Review Board, Planning Board B) Any Financial, Familial or Professional Relationship City Commission IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLATRATEOR 07f/ERj. '~ ~'~} ~ A) LOBBYIST DISCLOSURE: (Required) $S~`~J ©~~ <`~~~~ - B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). The following information must be answered: 1) Pursuant to Miami Beach City Code Secpon 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement Issues": 0o Y~ o• Are you lobbvina on a present or pending, bid for aoods. eauioment or services, or on a gre~p~* or Dendina award for aoods eauiioment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ~polication for chance of zoning man designation o~hange to the Citv's Future Land Use Man? 3) Pursuant to Mfami 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 anot-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.. 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 LENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES COMPENSATION DURING THE REPORTING PERIOD. ~~\ a roduced ID DE License #1510967 « j ~~ Form of Identification i ll L bb t k y nown ( o y s ) ^ Persona i sr ~ Z ~~ ~ . II. SIGNATURE AND STAMP OF NOTARY: ~~ fate of Florida, County of Miami-Dade o and subscri befor me ~ day of 20 . o ure of Public N tary -State of Florida t~arization of Lobbyists signature I do solemnly swear familiar with the prop requirements. Signature of Lobbyist: all of the for going facts are true nd rrect and that I have read or am i contained jr~Section 2-482 of th Mia i Beach City Code and all reporting Signature of Principal/Client: VI. LOBBYIST IDENTIFICATIO FOR CLERK' SE ONLY / Annual Registration fee: [ ]Yes [ ] No Amount Paid "~ MCR # Date Paid (0 Lobbyist Registration Form received and verified by: _ F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc Revised 12/08/04 q PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification .~1~II''OJflAIIQ110H~i.it.~^?V IIN'.3!.!i3QrrOH Personally known (Principa?xOZ `SZ ~i~t sa.ridx~ ;• r Z£ZSZLQQ # 'aotss~tIIruo~ -i esauuo n aur,.ia VQRIOZd d0 iIZLVJ.S'OPISl1d E2IVJA11 State of Florida, County of Miami-Dade Sworn a subscribed befor e This y f h _f Signat Public Notary - S e of Florida Notarization of Principal' ignature IY. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, :,... FEAT RATE OR OTHERf a A) LOBBYIST DISCLOSURE: (Required) $ ~~Q . ~~ "~ T1~V V` B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 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 ~No• Are you lobbvina on a present or Dendina bid for aoods equipment or services or on a Dresent or Dendina award for aoods, equipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": nYpS ~o• Are you lobtlYina on a Dendina application for a Development Agreement with the City or ~pli tion for change of zoning map designation or chance to the Citv's Future Land Use MaD? 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 anot-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 ~Fio• Are you renresentina 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 LENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EIDITURE O COMPENSATION DURING THE REPORTING PERIOD. ~ of Lobbyist I do solemnly swear that f the familiar with the provisions con e requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION facts are~rue and rrect and that I have read or am ~ 2-482 f the i Beach City Code and all reporting PRINCIPAL IDENTIFICATION: Produced ID DE License #1510967 ^ Produced ID Form of Identification '~b ~ ~ ~. ^ Personally known (Lobbyist) t. II. SIGNATURE AND STAMP OF NOTARY: m~~ Z c, ~~ tate of Florida, County of Miami-Dade ~ v wo and subscrib d be re e~ ~ : ~ ~ h' day of /20~ ~ ~ .~ g re of Publ Notary -State of Florida ~ o ization of Lobbyists signature Form of Identification ^ Personally known (Principal) State of Florida, County of Miami-Dade Sworn and subscribed before me This day of . 20_ Signature of Public Notary -State of Florida Notarization of Principal's signature FOR CLERK' SE 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_ ~ n,(~ n /p Revised 12/08/04