Jeffrey Bercow - 820 Lakeview Drive, LLCi
MIAMI
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. 200 South Biscayne Boulevard, # 850, Miami FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-377-6220 305-377-6222 JBercowgBRZoninaLaw.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: �} CM
820 Lakeview Drive LLC -;
NAME OF PRINCIPAUCLIENT: ,
7481 SW 50 Terrace Miami FL 33155 °=E
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER:(305)666-6555 FAX NUMBER: (Optional) EMAIL: (Optional) U0
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)]
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: On One Group,LLC,c/o Sergio Artigues
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: Emilio Cubero 50%,Sergio 8 Marlene Artigues 50%
.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 820
Lakeview 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(8)Any Financial, Familial or Professional Relationship
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Formrevised 5-30-2012.doc �T3
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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): $600.00/hour
(REQUIRED).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Issues":
_Yes)MO: Are you lobbying on a present or Dendina bid for goods,equipment or services.or on a present or vending
award for aoods,eguipment or service?
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes)No: Are Xou lobbying on a vending aDDlication for a Develovm _nt Agreement with the City or avvlication for
change of zoning map designation or change to the City's Future Land Use MaD2
3) Pursuant to Miami Beach City Code Section 2-482 (h)Any person (except those exempt from the definition of"lobbyist"as set
forth in Section 2-481 above) who only appears as a representative of a not-for-profit corporation or entity without
special compensation or reimbursement for the appearance, whether direct, or indirect, to express support of or
opposition to any item, shall register with the clerk as required by this section but, shall not be required to pay any registration
fees.
Yes)No: Are you representing a not-for-Drofit corporation or entity without special compensation or reimbursement_
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF C C la CLERK
OATH, LISTING LOBBYlbirg EXPENDITURES. AS WELL COVI _IX&CEIVED. IN THE PJIX QF MIAMI 13EACH
EQ,$ THE PIRECEIDIbIra CALEN12AR YEAR, A STA E SHALL BVAL-1213 EVEbj IP--fHERE HAVE BEEN NO
EXPENDITURES OR C
Si tur obbyist
I do solemnly swear that all o he regoing are tr a and co r ec and that I have read or am familiar with the provisions contained
in Section 2-482 of the Mia Be ch City C d al eportin quirements.
Signature of Lobbyist:
Signature of Principal/C'ent:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
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Form of Identification '. _ Form of Identification 4i o
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Personally known(Lobbyist) m K Personally known(Principal) . .o.
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VII. SIGNATURE AND STAMP OF NOTARY: ° rn K Z
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State of Florida, County of Miami-Dade Ln a State of Florida, County of Miami-Dade a C
Sworn to and subscribed before me o Z Sworn a d subscribed before me
This 3Q-9 da of oJo�w1 20 2 n Z a m
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Signature of Public NotaryU StaW of FI a r" Signature f Public ry—State of Florida
Notarization of Lobbyist's signatur Notarizat n of Principal's signature
TO BE COMPLETED jj.X CITY CLERK'S AF O Y
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Dgte
Lobbyist Registration Form received and verified by:
AAIAMI BEACH
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 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 lobb "st, who fails to file the required Statement by April 30th, 2012, shall be
autom lly suspended om lobbying un ' II fines are paid, unless the fine has been
appe a to the Miami- a County Co ission on Ethics and Public Trust.
SI ature: D te:
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