Douglas Wood/304-312 Ocean Drive, LLC?~ MIAMIBEACH
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 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.
Wood Douglas S
NAME OF LOBBYIST: (Last) (First) (M.I)
Douglas Wood & Associates, Inc. 299 Alhambra Circle, Suite 510 Coral Gables Florida 33134
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 461-3450 (305) 461-3650 inboxCla douglaswood.biz
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
304-312 Ocean Drive, LLC
NAME OF PRINCIPAL/CLIENT:
600 North 3rd Street. 2nd Floor Philadelphia PA 19123
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(215) 625-9722 (215) 625-0167 louisiorocofskyl@earthlink.net
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: Phillip McFillin, Louis Orocofsky
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: Phillip MCFillin
II. SPECIFIC LOBBY ISSUE:
Redevelopment of 304-312 Ocean Drive - COA, Variance Approvals, and Conditional Use Permit
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
Planning Dept., HPB, BOA, Planning Board, City Commission * None
~~i ~~Q S.~?_?~l~
00 ~~~ ~"~ ~ ~ ~fi~ BQOZ
* Unless an issue is legislative in nature, HPB, BOA, Planning Board, and City Commission members are not I~l~ q~si~le~d f~t~i~earing setting.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required) $165.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $165.00 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 nding bid for goods equipment or services or on a
present or pending award for goods equipment 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 lobbying on a pending application for a Development Agreement with the Citv or
application for change of zoning map designation or change 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 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 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 CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURF~ OR CS)J~IIJR~ENSATION DURING THE
REPORTING PERIOD.
i n ure of Lobbyist
I do solemnly swear that all of the f going f are true and correct and that I have read or am
familiar with the provisions contain n Se 2-482 of the Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client: -
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
^ Produced ID ^ Produced ID
N Form of Identification
~ ~ i°oV ~ Personally known (Lobbyist)
OD
~ ~ ~ I. SIGNATURE AND STAMP OF NOTARY:
c
•~ to of Florida, County of Miami-Dade
_ •~ ~-orn to and subscribed before me
~ ~"is _~ / day of ~ /~ 20 ~?~
Y ~,X~~-'
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This day of , 20_
of Public~t"6~a(y -State of Florida
lion of Lo byisYs signature
Signature of Public Notary -State of Florida
Notarization of Principal's signature
FOR CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid ~O ~` MCR
Lobbyist Registration Form received and verified by:
F:\CLER\~ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.da
Entered By:
ate Paid ~~ v
9
Revised 12/08/04
lV. UlDGLV~UKt Ut 1 tKM~ AIYU AMVUIV 1 ~ Vr LUKtfT1S1 l.Vh71't1Y~A11UIV r,Ul~GLV~t WI'1C11'1tK /'fUUKL I,
FLAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required) $1~7 00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ Ib5.00 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 lobbvina on a vresent or vending bid for goods equipment or services or on a
present or Wending award for goods eauipment 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 vending avvlication for a Development Agreement with the Ciri or
avylication for chance of zoning map designation or chance to the Ciri's Future Land Use
Man?
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 X No• Are you revresentina anot-for-profit corporation or entiri 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
RECENED, IN 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
^ Personally known (Lobbyist)
Form of Identification
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of , 20_
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
~ Personally known (Principal)
P~ Ph Ala
State of Flerada, County of 1~4ierrri°D~'tfe
Sworn. nd subscri d before me p
This day of , 2,~6C1
Signature of Public Notary -State of Florida Signature of P blic N6l~~Y~~
Notarization of Lobbyists signature Notarization f Pri~i•Ibi~l~• County
My Commission Tres ecember 11,2010
FOR CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # Date Paid
Lobbyist Registration Form received and verified by: Entered By:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc Revised 12/08/04
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GlTY CIEREC Gffce CrfCE~rkm;am~?-~aeh~(.gov
~sE: 3t~5.&73.Td? 1 , f'csx: 335.673.7254
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i understand that no later than:.. Caber st f each. fir, 1 must file .the following
farms, pursuant to Ssction 2-485 of the lvliami Beach City Code, with the City Clerk's
Office 'for all active lobbying issues.
1 ~ i.obbyist Expenditure Farm
2} Disclosure Form
Fa;lure to file these farms on a timely basis will result in my name being transmitted to the
Miami-Dade County Commission on Ethics ancf for code violation evaluation.
Ir addition, once at~issue I have registered to Cabby on has been resolvad, l am required
to imrned;ately notify the City Clerk`s CC}ffice cif CobEyist withdrawal in writing.
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Signature: / o«~ ~s f~~~ > ~1.~~~~,.t ~- Date:
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