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Jeffrey Bercow - Twenty-Two Star Island LLC VkIAMI B � G 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. Bercow Jeffreu NAME OF LOBBYIST: (Last) (First) (M.1) Bercow Radell&Fernandez, P.A. 20Q South Biscayne Boulevard, # 850, Miami FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-377-6220 305-377-6222 JBercow(R13RZoninaLaw.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: Stuart A. Miller NAME OF PRINCIPAUCLIENT: f Twenty-Two Star Island LLC 700 NW 10714 Avenue Miami FL 33172 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-229-6554 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:See attached. • 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 Design Review Board, Board of Adjustment, Planning Board, Land Use Development Committee, and City Commission, if necessary, relating to the property located at 22 Star Island Drive, Miami Beach,Florida. 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, Building and Public Works staff None. PB, DRB, 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 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 1,4� ► l I I q1 C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.0u ook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc 7 i P_�*'3 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)$600.00/hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $600.00/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)No: Are you lobbyjna on a present or pending bid for goods,eauipment or services. or on a present or pendina award for oog_ ds,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 JCNo: Are you lobbying on a pending application for a Develooment 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 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)CNo: 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 SHA SUBMIT TO THE CITY CLERK RECEIVED,QATH. LISTING LOBBYING EXPENDITURES, AS WELL AS,.,dQMPENS TION C C FHB THE PRECEDING EXPENDITURES OR COMPENSATION DU PERIQD-.//�� Sign r o obb is I do solemnly swear that all of the foregoing facts are true an correct d that I e read or a amiliar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting requir ments. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID Form of Id 1)(407)..3'98--0153 RISTINA DIANA GONZALFZ Form of Identification MY COMMISSION#FF083128 ?' :"O. EXPIRES ES March 23,2oi8 Personally known(Principal) Personally known(Lobbyis Floridallotaryservice.com VII. SIGNATURE AND STAMP OF NOTAR r► R.MUELLER t ...y State of Florida, County of Miami-Dade ! MY COMMISSION 5.201 706 tate of Florida, County of Miami-Dade EXPIRES:SEP 25,2017 orn an ubscrib d before me Sworn to a d subscribed before a °P Bonded through 1st St uranc This 2-°► — day of I, 2014 s ay of 2014 Signature of Public Notary tate f Flori Sig ature of Public Notary—State of Florida Notarization of LobbYlst's signature NN arization of Principal's signature r� TO BE COMPLETW DX CITY CLERK'S T F O Y .G tobbyist nnual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# e Paid Registration Form received and verified by: MIAM-1 BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamlbeachfl.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov Tel: 305.673.7411 , Far: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 Statement or pay the assessed fines after notification. Any I ist, who fails file the required Statement by April 30th, 2012, shall be auto, ati ally suspend d om lobbying un fl-all fines are paid, unless the fine has been appeale to the Miami-D de County Co fission on Ethics and ublic Trust. � L J Sign u Dat . C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc DISCLOSURE OF INTEREST Twenty Two Star Island, LLC 700 NW 107th Avenue Miami, FL 33172 100% SM Alpha LLP 700 NW 107th Avenue Miami, FL 33172 98 % Stuart A. Miller 2010 Family Irrevocable Trust 700 NW 107th Avenue Miami, FL 33172 1% S. M. Stuart Miller Irrevocable Trust 700 NW 107th Avenue Miami, FL 33172 1% SM Alpha, LLC (owned 100% by Stuart A. Miller) 700 NW 107th Avenue Miami, FL 33172 I F. L_ f m ® 1 ®. ❑ •� -1 C .� a Z < 0 on 7-r ,� tr zs, = - a p y - ` m 4' IN �37 f� t, o