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Monika Entin MIAMI BEACH 90 6,A) 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. Entin Monika NAME OF LOBBYIST: (Last) (First) (M.1) Bercow Radell & Fernandez, PA 200 South Biscayne Blvd., Suite 850 Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 374-5300 (305) 377-6222 mentin@brzoninglaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please,notW this office if your,contact information.changes,address,rvphone,;ord mail address I. LOBBYIST RETAINED BY: Joe Porrello, trustee of 520 Lakeview Ct. Land Trust NAME OF PRINCIPAUCLIENT: Law Offices of Joseph A. Porrello, P.A. 7875 SW 104th Street, Suite 103 Miami FL 33156 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 374-0092 Joe @PorrelloLaw.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: Laszlo Fazekas IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Laszlo Fazekas 1 II' 1000 C'L0BBYISSUE.' Development Approvals and Permitting Issues,including Lot Split for Property located at 520 Lakeview Ct,Miami Beach,FL Issue to be lobbied(Describe in detail): _.... _._.. —1.1 _-_�.....,.. . .... �,_.• ul CITY AGENCIES/INDIVibU'ALS,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,stating 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 Planning Department and Building Department Staff None B, HPB, BOA, City Commission, as necessary* None Pursuant to City Code Section 2-482(8)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 Any Financial,Familial or Professional Relationship JI A '0 S,'1� 5 X113 F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)$310.00 B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (Required). $310.00 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 Now Are you lobbvina on a oresent or pendina bid for goods.eauioment or services.or on a present or pending award for aoods.eauioment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": Yes X Nos Are you lobbvina on a oendina application for a Development Aareement with the City or application for chanae of zonina map desianation or chanae to the City's 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 a not-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 representina a not-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON FEBRUARY 28th 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 EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist I do solemnly swear that all of the foregoing facts are true d 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 r orting a ts. Signature of Lobbyist: Signature of Principal/Client: 7�e VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID Form of Identification Form of Identification Personally known (Lobbyist) Personally known Will Public State of Florida (Principal)VII. fer Nieves GNATURE AND STAMP OF ommission DD817296 NOTARY: es 0812412012 State of Florida, County of Miami-Dade Notary Publie State of FloridaSta of Florida, County of Miami-DadeSworn to and subscribee4before me Diana Ramos Sw n d subscrib d bef re me This J day of , 2012 My Commission EE082284 hi d f 2012 r%u"' Expires 04110/2015 JA Signature of P blic Notary—State of Florida Signatu2FF blic tary—State of Florida Notarization of Lobbyist's signature NotarizPrincipal's signature TO BE COMPLETED BY CITY CLERK'S NLY / Q Annual Registration fee: [ ]Yes[ ]No Amount Paid$ 5V MCR# V Date Paid 3 r Lobbyist Registration Form received and verified by: MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive,Ivfiami Peach, Florida 33139,www.miarribcachfl.aov CrIY CIERK Office CityClerk@niamibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 LO B B Y IS T N A M E: Monika Entin I understand that no later than February 28th of each year, I trust file the following fornj pursuant to Section 2485 of the Mani Bleach City Code, with the City Clerk's Office for all active lobbying issues. 1) Lobbyist Expenditure and Compensation Forrn 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 0 ffice of lobbyist withdrawal in writing. Pursuant to Section 2485 (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 2485 .1 , a fine of $50.00 a day shall be assessed for all Statement(s) filed afterthe 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 30th, 2012, shall be automatically suspended from lobbying until all fines are paid, unless the fine has been appealed to the MiamiDad.e__C_ounty Commission on Ethics and Public Trust. -16 ZZ- Signature: Date: FACLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc