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Alfredo J. Gonzalez/Diversified Construction & Restoration1-Pk~srii Be~itt i a~ rrw~w~ .~. :S!lr3 City of Miami Beach OfFce 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 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. Gonzalez Alfredo J 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) 305-579-0588 305-961-5588 gonzalezaj@gtlaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Diversified Construction & Restoration NAME OF PRINCIPAL/CLIENT: Diversified Construction & Restoration 12555 SW 130 St. Miami, Florida 33186 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zp Code) 305-246-4306 305-246-4328 TELEPHONE 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: Jerry Guarch • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Jerry Guarch II. SPECIFIC LOBBY ISSUE: HPB Hearing on property located at 4747 Collins Avenue Issue to be lobbied (Describe in detail): III. CIfY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title Board of Adjustment /Historic Preservation Board Building Department B) Any Financial, Familial or Professional Relationship Planning Department IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLATRATEOR O77lERf ~ r, ~s . g '~ N j~~j . ~ •`~~' U Q Z° `~~w r ~t ~~ qa. s~` A) LOBBYIST DISCLOSURE: (Required) $355.00 Hourly B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $355 00 Hourly 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 lobbving on a prp~nt or Dendina bid for goods eauiument or services, or on a present or pending a~~ard for goods eauiument or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^Yes ~ No Are you lobbvina on a p nding application for a Development Agreement with the City or -ppii 'ion for chance of zoning map designation or chance to the C~t~'~ Future Land Use Mao? 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 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 ,C~No Are you representin- a nit-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 P CEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPE ITU S OR COMPENSATION DURING THE REPORTING PERIOD. x. ure of Lobb I do solemnly swear that al of the foregoing facts are tru d correct and that I have read or am familiar with the provisions `ontained in Section 2-482 f Miami Beach City Code and all reporting requirements. Signature of Lob ' t ~ _ /. Signature of Principal/Client:' '' r T -,~~_ ~'° yqy ~ ~ ~yq i VI. LOBBYIST IDENTIFICATION: P~ RIN~AL IDENTIFICATION: Produced ID ['Produced ID Form of Identification Fo~dentification Personally known (Lobbyist) VII. SIGNATURE AND STAMP OF NOTARY: State of Florida, County of Miami-Dade Sworn to and subscribed before me This '~ 20 08 r ignatur o i otary -State of Florida Notarize ion Lo byist's signature FOR CLE 'SRI Uv,SE ONLY ~~~ Annual Registration fee ]Yes [ ] No Amo aid ~~ R # ~?9~ ~ Date Paid lobbyist Registration Form received and verified by:~' F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05. Revised 12/08/04 rsonally known (Principal) ~~ . State of Florida, County ~ IO:FIRYHERNANDQ Sworn a ~ subscrib d f ~~ ~ 's ~' ~Y COMMISSION # DD 626373 This ~~)ry 9f # ~ EXPIRES: May 3,2011 ' ;tti~ Bonded Thru Notary Public UnderxrtNera Signature'of Public`N - Notarization of rincipal's signature t ~~ F ~ f ~M City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, vnvw.miamibeachfl.gov CITY CLERK Office Tel: 305.673.741 1 ,Fax: 305.673.7254 LOBBYIST NAME: i~r~, CityClerk@miamibeachH.gov I understand that no later than October 1st of each year, I must file the following forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's Office for all active lobbying issues. 1 j Lobbyist Expenditure Form 2~ Disclosure Form Failure to file these forms on a timely basis will result in my name being transmitted to the Miami-Dade County Commission on Ethics and for code violation evaluation. In addition, on an issue I have registered to lobby on has been resolved, I am required to immediat~:~~otify the City Clerk's Office of lobbyist withdrawal in writing. -v ~ nature Date: Ravisa~i :1.?_1~4~2QOS