Gil, Michaelm MIAMIBEACH
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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 teen "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
Gil Michael A
NAME OF LOBBYIST: (Last) (First) (M.I)
Bercow, Radell & Fernandez P.A. 200 South Biscayne Blvd., Suite: 850 Miami, Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 377-8690 (305) 377-6222 mgil@brzoninglaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Alan Waserstein
NAME OF PRINCIPAL/CLIENT:
South Shore Landowners. LC 280-330 South. Shore Drive Miami Beach Florida 33141
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 827-8373 (305) 827-7133 wasrco@aol.com
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: Alan Waserstein
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: David Lifshultz, Daniel Lifshultz, Shayna Lifshultz, Richard Waserstein
II. SPECIFIC LOBBY ISSUE:
Board of Adjustment Application for 280-330 S. Shore Drive
Issue to be lobbied (Describe in detail): ~ ~ rv
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: ~ L°o
b. ,
A) Full Name of Individual/Tide B) Any Financial, Familial or Professional Relati~nshipt
- N
Planning Dept., BOA, Planning Board, City Commission * None
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* Unless an issue is legislative in nature, HPB, BOA, Planning Board, and City Commission members are not lobbied outside of a public hearing setting. ++
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FLAT RATE OR OTHER).
A) LOBBYIST DISCLOSURE: (Required) $ 220.00 cer hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 220.00 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 Wresent or ndin big d for goods, eauiument or services, or on a
present or Wending 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 lobbving on a Wending aWWliication for a Development Agreement with the City or
aRQlication for change of zoning man designation or change to the Citv's Future Land Use
MaW?
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-Wrofit corRoration 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 CTiY 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 ach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: NCIPAL IDENTI CATION:
Produced ID Produced ID
Form of Identification Form of Identification
N
° ~ a Personally known (Lobbyist) Per Wally kno n ri ~ TERESAL MARQUE~•
~j ~ ~ ~ ~,,~ MY COMMISSION M DD 653705
.~ S VII. SIGNATURE AND STAMP OF NOTARY: EXPIRES:Aptll3, 201t
a ~ E ~ ~ .' Bonded'mm Notary PubNo Underwrlterc
~ ~ ~ a State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
z m ~ w Sworn t and subscri befpre me ~ Sworn d subscrib fore me ~/
~ This a o 20_ This day of~~, 20-' i
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~O"''~ Si atur Pu he Nota
ry -State of Florida Signature of Public Notary - a e of Florida
N tariz ion of Lobbyist's signature Notarization of Principal's signature
FOR CLERK'S USE ONLY ~}
Annual Registration fee: [ ]Yes [ ] No Amount Paid 7, 2~~-MCR ~'! ~ ate aid Q
Lobbyist Registration Form received and verified by: Entered By:
F:\CLER\#ALL\MARIA-M\LObbyist\LOBBYIST foRM OS.doc Revised 12J08/04
~~7 ~ Miami 66ach, 1700 Convention Center Drive, Miomi Beoch, Florida 33139, www,miomibeochfl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fox: 305.b73.7254
CifyClerkemiam ibeachfl. gov
LOBBYIST NAME: t L ~a.{ Cj ~
I understand that no later than Qtr left ~ ea~ti vcar~ I must file the following
forms, pursuant to Section 2-4$5 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
1) 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-0ade 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.
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Signature:
Date:
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