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Michael J. Marrero - Trung Nahia Duong r PH City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139®13D EC i LOBBYIST REGISTRATION FORM �3 C/ Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to enco6r9g9,4he7 passage, dUat or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recomke diitop to the City Manager or any city board or committee; or any action, decision or recommendation of any city personnel during the time PE�6-dof 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. Marrero Michael J. 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 mmarrero&brzonina law.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: le NAME OF P INCIPAL/CLIENT: Z!22M c, S°L ADZ Miami Beach Florida 33140 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 753-1119 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: —T t-� Y► �C> • IDENTIFY ALL PERSONS HOL ING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ii.SPECIFIC LOBBY ISSUE: Development Board Approvals for 3300 Chase Avenue, Miami Beach, Florida 33140-- i>2'1 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 relationship. 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 X PB, HPB, BOA, City Commission, as necessary* None X 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(g)Any Financial, Familial or Professional Relationship C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $425 B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). $425 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 present or pending bid for goods,equipment or services.or on a present or gend*ng award for goods,eauipment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": Yes X No: Are you lobbying on a pending application for a Development Agreement with the City or application fig change of zoning map designation or change to the City's Future Land Use Map? 3) Pursuant to Miami Beach City Code Section 2-482 (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 28 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 ME THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR 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 M Beach 'ty o reporting requirements. Signature of Lobbyist: Signature of Principal/Client T< VI. LOBBYIST IDENTIFI ON: d�.ti PRINCIPAL IDENTIFICATION: ,a o o� Produced ID %a���c Produced ID -al Form of Identification o o Form of Identification MM ZPersonally known (Lobbyist) o 3 3 °Z1 7 c rsonally known (Principal) m x o O z 0 fir pN.B A to O 41� VII. SIGNATURE AND STAMP OF NOTARY: N o H a omrn m A3 ;c State of Florida, Count of Miami-Dade N °. i5 y B c County N State of Florida, County of Miami-Dade N; o �, Sworn nd subscri ed before me a Sworn d subscribed be me °m N This da. f 6ef,, 2013 m ; Thi day of /, 2013 — h -n N N U A -. 4 � � Signature of Publi Notary—State of Florida Sigri Se of ublic Notary—State of Florida Notarization of Lobbyist's signature Notarizatiod of Princil2al's signature TO BE COMPLETEBY CITY CLERK'S STAFF LY Annual Registration fee: [ ]Yes[ No Amount Paid$ MCR# Date Paid J Lobbyist Registration Form received and verified by: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc istratioti Forin.doc Revised 04/27/2 City of Miami Beach, 1700 Convention Center Drive. Miami Midi. Florida 33139, xN,-«-Nv.iiiiiiiijbeaclifl.go%, CITY CLERK Office Rafael F. Granado, City Clerk CityClerk -nibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: Michael J. Marrero I understand that no later than February 28 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, 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 $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 the ade County Commission on Ethics and Public Trust. 3 Signature: cate: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGODDH\Lobbyist Registration Formrevised 5-30-2012.doc Miscellaneous Cash Receipt - CITY OF MIAMI BEACH No. I Cash Credit Card 20 Received of A Address r For ►` -`` _,� r� 8 �� ;:�� ,`" '.. " € � _ � �"s,� -, � �. r k s f )�s d ,� '•�!�- #r fS �""5 - r"� �-���� ff`• �' y y�� .^ �t7� 4� it E°``{ i S (,.:4.J d -'���`' �i�f`�•'t..'; �... ..... - 4;...1' -..f�+„` r °•'�r,,,r.•. t% �!•y i (THIS INFORMATION MUST BE COMPLETED) Office of Finance"Director By Account Number• Preparers Dept: ! t EXT: