Mathew Amster - 1680 Michigan, LLC ? e BEACH 10
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.
Amster Matthew
NAME OF LOBBYIST: (Last) (First) (M.1)
Bercow Radell & Fernandez, PA 200 S. Biscayne Blvd, Suite 850, Miami, FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 377-6236 (305) 377-6222 mamster cDbrzoninalaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
1680 Michigan. LLC—Andrea Marroauin. Manager
NAME OF PRINCIPAL/CLIENT:
Same 9858 Glades Road, #238 Boca Raton FL 33434
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 909-4538/(305) 915-0269 (305)418-7461
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: Andrea Marroquin, Managing Member
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: Andrea Marro uin- 103%
II.SPECIFIC LOBBY ISSUE:
Development approvals and Dermitting issues for crocertv located at 1680 Michigan Avenue, Unit 100, Miami Beach, FL
Issue to be lobbied(Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4) include the commissioner or personnel sought to be lobbied,and whether the lobbyist has entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such
person's commencement of service with the city to the present date,s ting the general nature of the subject contractual relationshi .
Sec 2-482(a)(4) Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to be lobbied
Staff of Planning Department, Building Department,and Public Works None X
De artment
PB, DRB, BOA,City Commission,as necessary* None X
Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,familial or professional
relationship, or other relationship giving rise to an appearance of an impropriety,with any current city commissioner or city personnel who is
sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2-482(g)Any Financial, Familial or Professional Relationship
None
i 1 WV NAP an
*Unless an issue is legislative in nature,PB,DRB,BOA,&City Commission members are not lobbied outside of a public hearing setting.
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Formrevised 5-30-2012.doc f
I
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTNrER)' !P-325- Ar A) LOBBYIST DISCLOSURE:(Required) .00
3'=,s
B) PRINCIPALS DISCLOSURE(OF LOBBYIST COMPENSATION): (Required). .00 Air
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 pnom t or pendng bid for _oquipment or seryloW or on a present or
pending award for goods,equipment or swvlce7
2) Pursuant to Miami Beach City Code 2-490 Entitled VrdtbBed Campaign Contributions By Lobbyists On Real Estate
Development Issues":
pYes X No: Are you lobbying on a pencftg appication for a Davelopnrent Ammignennt with the City or application
for dugme of zoning map designation or charge to the Cur's Future Land Use MapT
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 a not-for-profit corporation or entity without special
compensation or reimbursement for the appearance,whether dam,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 a not-for-profit corporation or entity wiitlwut special compensation or
reimbui serpent.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28P 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 RWOVIMG
VeZrF r6n,__
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 n 2-482 of the Miami Beach and equi.enmits.
Signature of Lobbyist:
Signature of Principal/d'
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
9 W
h
0 Produced ID e o Q Produced ID
Form of Identi fica iv w o Form of Identification
kmonally,Personally known(L.obbyist) a E_�o known(Principal) *'" Notary Public State of Florida
Paola wagener
VII. SIGNATURE AND STAMP OF NO J Ex Commission EE098783
�w �a pd' Expires 0611912016
State of Florida,County of Miami-Dade :' •Y�0 State of Florida,County of Miami-Dade
Swo and before me Y a Sworn me
Th' t _ 20%Z--- s'ON. This day 20 1
OL
ure of Publ' otary State of Florida ture of Public Notary—State of Florida
Notarization of s signature Notarization of Principal's signature
FORwcs USE ONLY
Annual Registration fee: ( ]Yes[ ]No Amount Paid-�� -- MCR# 6$ v Date Paid
Lobbyist Registration Form received and verified by: S Entered By:
wevsed 1/11/2011
F:\CLE I
listration Form.doc Revised 04/27/2012
MrA M BEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granada, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.741 1 , Fax: 305.673.7254
LOBBYIST NAME: &qy /4 n-Gz
I understand that no later than F b____,�_ruanf„2B of gAgby9ar, I must file the following form,
pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's Office for
all active lobbying issues.
1) LOBBYIST EXPENDITURE AND COMPENSATION 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, or I am no
longer lobbying on that issue or for that principal, I am required to immediately notify
the City Clerk's Office of lobbyist withdrawal in writing.
Pursuant to Section 2-485 (d), the City Clerk shall notify any lobbyist(or principal) who
fails to timely file a Statement and in addition to any other penalties which may be
Imposed as provided in Section 2-485.1, a fine of$60.00 a day shall be assessed for all
Statements) filed after the due date. The City Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal)
to file the Statement or pay the assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 80th, 2012, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
Signature: Date:
C:\Users\clerhatlWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc