Monika H. Entin - 1800 Bay Road Investors Oj�
MIAMI BEAC =� g ,
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
:v
LOBBYIST REGISTRATION FORM a a
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the p*agenefeai6r
modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation he City
Manager or any city board or committee; or any action, decision or recommendation of any city personnel during the tir�e perod 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 H.
NAME OF LOBBYIST: (Last) (First) (M.1)
Bercow Radell&Fernandez, P.A., 200 S. Biscayne Blvd., # 850, Miami, FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-377-6237 305-377-6222 MEntinaBRZoninaLaw.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:
1800 Bau Road Investors, LLC C/O Greenstreet Partners, LP
NAME OF PRINCIPAL/CLIENT:
2601 South Bayshore Drive, 91h Floor Miami FL 33133
BUSINESS NAME AND ADDRESS(Number and Street) (City) (State) (Zip Code)
(305)858-4225 c/o bsarchick@areenstreetpartners.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: Jeffrey Safchik
IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: See the attached.
II.SPECIFIC LOBBY ISSUE:
Development Approvals and Permitting Issues, including, but not limited to Design Review Board, Planning Board, Board of
Adiustment and Citu Commission, irnecessaru, relatina to the nronerties located at 1800 Bau Road, 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 I NO
title of person to be lobbied
Planning Department and Building Department Staff None
PB, DRB, HPB, BOA, City Commission, and Land Use None
Development Committee, as necessary
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 town 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
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required): $375.00 per hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $375.00 per hour
(REQUIRED).
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 lobbyina on a present or nendina bid for aoods.eauigment or services.or on a present or
Dendina award for aoods.eauigment 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 gending application for a Development Agreement with the City or application
fQ[change of zoning mag designation or change to the CitVs 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 o: 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
MB THE PRECEDING CALENDAR YE613, EhLIZEML-L BE FILE12 EVEN IF MERE HAME BEEN NO
EXPENDITURES OR
Signa
I do solemnly swear that all of the foregoin s are true and corn a tt and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach Cit ode and all reporting requirements.
Signature of Lobbyist.
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identification
Personally known(Lobbyist) Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida,County of Miami-Dade State of Florida, County of Miami-Dade
Sworn t nd subscri before me Sworn and subscribed before me
This o _da I� ' 2010-1 This day of or ,201
YW--A(,X - - / a Ids��
Signa_ re o u ota —State of Florida Si natu a of Public Notary—State of Florida
Notarization of signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF.ONLY
e 01 •w �oo —Z,�.. ���������, I GEORGIA WILLI MS pit Lobbyist Registration Form received and verified by: °, o; rc- of Florida
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F:�CLE istration Form.doc Revised 04/27/2012
IV I A A/ .!.B.-E-A C"`**H
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Rafael E.Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: Monika H. Entin
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 amended from lobbying until all fines are paid, unless the fine has been
appealed the Miami-Da a County Commission on Ethics and Public Trust.
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Signatu Date
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1800 Bay Road Investors, LLC
Organization Chart
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('
Steven J. Green - 100% Basil Vasiliou-94.755%
1 shareholder Jane Vasiliou- 5.245%
"General Partner"
I
Beach Investn'ient Partners,
j Inc. "Limited Partner"
(Florida Corporation) VO VII Bay, LLC
33.3333%
Beach Investment Partners, LLLP
(Florida Limited Partership)
100%
1800 Bay Road Investors, LLC
(Florida LLC)
"Disregarded Entity for Tax Purposes"
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