Jeffrey Bercow - David Martinr
M I A/V I B E AC i-11
City of Miami Beach Office of the City Clerk 0 V
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.
Bercow Jeffrey
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 ibercow(c�brzoninalaw.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:
David Martin
NAME OF PRINCIPAUCLIENT:
Terra Group 2675 S. Bayshore Drive Miami Florida 33133
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 416-4556 (305) 777-3040 DMartin@terra-grour).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:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
II.SPE.CIF;IG L:OBBV,ISSUE:
Land Develo ment A rovals for 8701 Collins Avenue Miami Beach Florida
Issue to be lobbied(Describe in detail):
In.'CITY AGENCIES/IIVDIVIDUAL.& 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
Tanning Department and Building Department Staff None X
B, HPB,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
LU
;.!.
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQD6 i44\Lobbyisf'Registration
Formrevised 5-30-2012.doc
f
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) $575
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). 575
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 far goods eauiument or services.or on a present or
apdjpg award for goods,equipment 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 lobbvina on- """""""""F^'ji Devel oment AgEgemgnt with the City or application_
fQ[chaLlge of zoneng mi1p d iana ion or change to the City's Future Land
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 Noe Are you representina a ngt for profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
Obj FEBIJUARY 28 QE EACH YEAR, EACH LOBBYIST SHALL SUBMI QLERK SIGNED STATEME ' UND
EQH THE RECEQIHQ OMPg SAJION 12 (RING THE REPORTING PERIOD.
EXPENDITURES OR G.,.... �..�.-.
Signature of Lo yist
I do solemnly swear that all of the foregoing facts are true and corr t an that ha a r Xamm�ilriar with the provisions contained
in Section 2-482 of the Miami Beach City Code and all reporting re ire S.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identificati7_,,s Aye Notary Public State of Florida Form of Identification
` piana Ramos/ M Commission EE082284 Personally known(Lobbyist) ' oo-Q Expires 0411012015 ersonally known(Principal)
/f�
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida,County of Miami-Dade State of Florida, County of Miami-Dade
Sworn to a d subscribed/�b^�eff�/oorA/(�f(�me \•11111" SANDRA RAMOS worn and subscribed before me
V l V'"' `%�PpY P�B�i�
This day, , 201 �$ Commission# EE 17854 T is o? d of �l'-CI'I'11D013 AAA*=
- My commission
OPT
,,rF OF F`%%%%� April 30, 2
Signa re of Pu li Notary-State of FI of Public ary-State of Florida
Notarization of Lobbyist�'s signature N6taiQzation of Principal's,signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY 1,�IN /Annual Re istration fee: [ ]Yes[ ]No Amount Paid$ MCR# � << Date Paid 1J
9
obbyist Registration Form received and verified y:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
istration Form.doc Revised 04/27/2012
V1
I m k.A k
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk@miamibeachfl.gov
Rafael E. Granado, City Clerk
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: Jeffrey Bercow
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 State nt or pay the assessed fines after notification.
5
Any lobbyist w o fails o file the required Statement by April 30th, 2012, shall be
automaticall S pende rom lobbyinguntil all fines are paid, unless the fine has been
I j
appealed to th Miami- County mmission on Ethics and Public Trust.
1q/Y/ 2,,
Signature: Date:
C:\Users\clerhatl\AppData\Locai\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Forrnrevised 5-30-2012.doc
I
t
s
m _ CL n n
• 0
• O �
In
cr
!C O
lir-
ca 2L
CD
CD
to
J V j
s ±
}
` O
•• m iry�'-
O
O