Monika Entin - 120 Ocean Drive, LLC MIAMI BEACH
City of Miami Beach Office of the City Clerk �N DIP
`Z
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(a-brzoninglaw.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:
I. LOBBYIST RETAINED BY:
120 Ocean Drive, LLC .
NAME OF PRINCIPAUCLIENT:
120 Ocean Drive, LLC -2675 S. Bayshore Drive, Coconut Grove, FL 33133
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)416-4556 (305) 377-3040 DMartin@terragroup.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:David Martin
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY ISSUE:
Development Approvals and Permitting Issues,including,but not limited to Historic Preservation Board and Planning Board approvals for modifications to
design and robotic/mechanical parking for the property located at 120 Ocean Drive,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,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
PB, DRB, HPB, BOA, FPCity Commission, as None
necessary*
Pursuant to City Code Section 2-482(g) Every registrant shall be required Pursuant to City Code Section 2-482(g)."err�e-Ois"trarit�`s._half
required to state the extent of any business,financial,familial or professional relationship,or other relationship giving nse to an appearance
of an impropriety,with any current city commissioner or city personnel who is sought to be lobbied as identified on t I bb ' re� tract, r n7 Nir form filed. e iG n
Sec 2-482(g)Any Financial,Familial or Professional Relationship
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.
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(Required)._$310.
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 present or pending bid for goods,eguipment or services.or on a present or nendina
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 Now Are you lobbvina on a pending application for a Development Agreement with the City or application for
change of zoning map designation or change 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 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 representing 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
QAIH, LISTING LOBBYING EXEENDITURES, AS WELL AS COME914SA-119L BE gIVED, IN JHE !Q1IY QE MIAMI BF.ACH
EM THE PRECEDING CALENDAR YEAR. A STATEMENT---SHALL BE FILED EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR COMPENSATION DURING THE REPORTING PERLOD.
_-
���. Signa..
I do solemnly swear that all of the foregoing facts are true and collect and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach Ci Code and all reporting requirements.
Signature of Lobbyist:
9 Y
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICAT - PRINCIPAL IDENTIFICATION:
❑ Produced ID ❑ Produced ID
Form of Identifi Form of Identification
BETTY UERM
❑ Personal) known(Lobbyist) ; MY II�.SION#BD 960413
Personally ( y ) I EXi S: ,6,2014 personally known
' Bonded Thru NMY PUMIG Uft(IW Biers
(Principal)VII. SIGNATURE AND STAMP OF
NOTARY: SANDRA RAMOS
1.•`��a�a ue�i.
s `'� Commission#EE 178548
State of Florida, County of Miami-Dade My Commission Expires S 4rnnd lorida, County of Miami-Dade
Sworn to and subscribed before me '�����OFF�°a\o�`` Aprll 30, 2016 S subscrib d befo a me
This �1 day of D2C , 2012 "" day of Ue P.f,'2012
a 14
At% J) AVU Sign ure ofP41ic Notary—State of Florida SignajXre/ofPydbfic Nota State of Florida
Notarization 0-1 Lob®signature Nota iza ion of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
2 g � 4411 3
Annual Registration fee: ( ]Yes[ ]No Amount Paid$ MCR# J ( at Paid
Lobbyist Registration Form received and verified by:
I I
r
I\A I AM I B EAC H
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 331.39,www.miamibeachfl.gov
CITY CLERK Office CityClerk@i-niamibeachfl.gov
miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: Monika Entin
I understand that no later than February 28th of each year, 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, 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 $50.00 a day shall be assessed for all Statement(s)
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 30th, 2012, shall be
automatically suspended--from lobbying until all fines are paid, unless the fine has been
appealed to .lie Miami-Dade County Commission on Ethics and Public Trust.
Signat e: Date:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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