Andrew W. Frey/Akerman SenterfittFl nrn Er~Afir
~~~
City of Miami E~each C7ff~ce cf the City Clerk
1700 Cr~nvention Center Drive, Miami BPach, >=l 3313~.t
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.
Frey Andrew W.
NAME OF LOBBYIST: (Last) (First) (M.I)
Akerman Senterfitt One SE Third Avenue, Ste. 2500 Miami FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 374-5600 (305) 375-5095 andrew.frey@akerman.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Publix Supermarkets, Inc.
NAME OF PRINCIPAL/CLIENT: (Last) (First)
(M.I)
3300 Publix Corporate Pkwy. Lakeland FL 33811
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(863)688-1188 (863)284-5532
TELE~'HONE 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:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR
MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP
OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Site plan approvals for redevelopment of Publix Supermarket on 69`~ Street and Collins
Avenue
Issue to be lobbied (Describe in detail):
{ M2719690; ] }
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A. Full Name of
Individual/Title B. Any Financial, Familial or
Professional Relationship
City Commission None
Planning Department None
Planning Board, Design Review Board,
Zoning Board of Adjustment None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION
(DISCLOSE WHETHERHOURLY, FLATRATE OR OTHER):
A. LOBBYIST DISCLOSURE: (Required) $270.00 hourly
B. PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required)
Same
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 lobbying on a present or pending 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 Rea] Estate Development Issues":
^Yes ®No: Are you lobbying on a pending application for a Development
Agreement with the City or application for chance of zoning
map designation or chance to the City's Future Land Use
Map?
(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 ®No: Are you representing anot-for-profit corporation or entity
without special compensation or reimbursement.
{M2719690;1 } 2
V. SIGNATURE UNDER OATH:
ON OCTOBER 1sT 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 EXPENDITURES OR COMPENSATION DURING THE REPORTING
PERIOD. ~
~,f.-,
`~
Signat o Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and that 1 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 PrincipaUl
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
[personally known (Lobbyist)
Form of Identification
^ Personally known (Principal)
VII. SIGNATURE AND STAMP OF
NOTARY:
State of Florida, County of Miami-Dade
Swot-t~o and subscribed before me
Th' day of , 20~
State of Florida, County of Miami-Dade
Sworn and subscribed before me
This -day of , 20
Signature of Public Notary -State of Fl ri a Signature of Public Notary -State of Florida
Nota YP Notarization of Principal's signature
~v~' o~ Notary Public State of Florida
Blanca E Fernandez
~ My Commission DD793476
~o-n~ Expires 06/25!2012
FOR CLERK'S USE ONLY
Annual Registration fee: ^Yes ^No Amount Paid ~~ MCR # Date Paid ~ z Z`
Lobbyist Registration Form received and verified by:
Revised 12/08/04
PRINCIPAL IDENTIFICATION:
^ Produced ID
{M2719690;1 }
4. COMPENSATED LOBBI'IST:
The City of Miami Beach Code sub-section 12831 requires the disclosure of any individual or group which has
been, or will be, compensated to either speak in favor of or against a project being presented before any of
the City`s Development Review Hoards, or not to speak at all. Please Ilst below ap persons or entities
encompassed by this section.
HAMS ADDRESS PHONE # 7'O SPEAK NOT TO
a Nelsen O. Kasdin 1 SE 3rd Ave, 33131 {305) 982 5629 pip con SPEAK
.Y
b Andrew Frey 1 SE 3rd Ave, 33131 (305} 982 5510 X
c Mark Van Dyke 300 SE 2 St, 33301 X
Additional names can be laced on a ~€ $4 ~ 627-tta95 ____
p pars a page a shed to this form.
* Disclosure shall not be required of any entity, the equity interest in which ate regularly traded
on an established securities market in the United States or other country, or of any entity, the
ownership interests of which are held in a limited partnership consisting of more than 5,000
separate interests and where no one person or entity holds more than a tots[ of 'S% of the
ownership interests in the limited partnership,
"The appAcant, hereby attests that the d'esdosure infomtatfion rested an this application is ~a full disdosure of a}I parries of Interest in this
application txi the best of my knowledge and belief.
s~,z...n.~ _ ..,ter a, m,am, cearn ana an omer~nentoratnanc~
PERSON 5t18MITi1[NG APPLICATION:
' nature
razler
Print Name
STATE AFFI(JATIpN WITH AP(x.ICANT (i.e. Agent, Architect, Attorney, Contractor, etc.)
863-68&1188
Phone # . h
S ~i§R,~~,~ore me this ,~ • daffy of .p~r'T-he fon~joing instrument was admawledged 6dore me
biC~--~~il.~Awho has produced ! ~ s identlftcatlon and/or is y imwm to me a4d who
did/did not take an oath. ,, ~---7r -T ~
SPATE OF FLORIDq
COt1NTY OF Mfp1iB!°' ~D,
MY COMMISSION EXPIRES:
NAME
F:\GIAN~DnB\GE7lERAL\APPLCf NZ. DOC
~V li, 20Qi
o.r.rr....-...-. ~-.
•~.s*"fi•~•.,, PATRICIA CGOIEY
Wit' '`'. Commission DD 7493,;,
~- Expires A~~gust?fl, ~0.`
~`~` lbdaE llw Trol Ftin M,nxyu Yar•
.e,a•r...,,...-....
~~
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, vnvw.miomibeachR.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fax: 305.673.7254
CityClerk@miamibeachfl.gov
LOBBYIST NAME:
I understand that no later than October 1st of each Near, 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
2j 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, once an issue I have registered to lobby on has been resolved, I am required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
~--'
Signa re:
Revisad 02f04l20D8
~~~d
Date:
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