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Matthew Amster - Shay Kostiner jg i\j\A RRACH (T) 51/1 ) City of Miami Beach Office of the City Clerk y 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. Amster Matthew NAME OF LOBBYIST: (Last) (First) (M.I) Bercow Radell & Fernandez, P.A.200 South Biscayne Boulevard, # 850, Miami FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-377-6236 305-377-6222 MAmste BRZoningLaw.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: Shay Kostiner NAME OF PRINCIPAUCLIENT: 1521 Alton Rd, #304 Miami tPe°9 fet. FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-531-6750 sk4inc cl,gmail.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: N/A • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: /V/A II.SPECIFIC LOBBY ISSUE: Development Approvals and Permitting Issues relating to the property located at 44 Star Island Drive, Miami Beach, Florida. Issue to be lobbied(Describe in detail): lll. 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. X PB, DRB, BOA, City Commission, and Land Use None. X 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 None_ None. None. I IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)$400.00/hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $400.00/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 XCNo: Are you lobbying on a present or oendina bid for goods.eauioment or services.or on a present or pending 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 XNo: Are you lobbyina on a oendina application for a Development Aareement with the City or application for chanae of zoning map desianation or chanae 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. YesXNo: Are you representina 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 BEACI-t EQB THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR •►i __► c • ► ! : k • ■'- r_: • i "4 ' 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 Miami Beach City Code and all reporting re•,•,ir-ments. Af Signature of Lobbyist: -/.is' - A Signature of Principal/Client: �" . ..._ VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID Produced ID 04-0€11..._ 1 2. Form of Idertt c Form of Identification r��p`°;';s CRISTINA DIANA GONZALEZ 1 ii MY COMMISSION#FF083128 Personally known(Principal) Personally known (Lobbyist) E�:,r"`,�� -•'' o' EXPIRES March 23,2018 VII. SIGNATURE AND STAMP OF(04010111thi3 FloridatpteeyeeriiFecom ,''':e21 .J1!97N• State of Florida, County of Miami-Dade .io a, State of Florida, County of Miami-Dade Sworn to a d subscribed before me _a • c �e 6..'o: Sworr ..nd subscribed before me• gtOZ'9Z w :z= This I day of. .to?.--,,,A2,42...,2014 _ • S3U1dX3 •:*_ This//6 day of /JP 1f ,2014 6LZZ60 33 -}� HYMN Or)...'C.: /J,i ;-.0,42 Signature of Public Notary— to o lorid �'%,,�b8��H� .. ignatur�. :public Notary—State of Florida Notarization of Lobbyist's signature Notari at'•n of Principals signature TO BE COMPLETED BY CITY CLER 'S STAFF ONLY Annual Registration fee: [ ]Yes[ o Amount Paid$ ]b MCR# - _ ■ Date Paid 16419 19 V40/ Lobbyist Registration Form recei and verified by: (i: a > s LA ,A, Al * F: s ss . AI I City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139. www.miamibeachtl.gov CITY CLERK Office Rafael E. Granath), City Clerk CityClerk clmiamibeachfl.g ov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: Matthew Amster 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 Miami-Dade County Commission on Ethics nd Public Trust. . /060,4 Signature: Date: r ' t ;-._,:;.-:,:t-1 t 1:. +,t 1, '..1.1.;2:0 14 #,t01 i.1 Miscellaneous Cash Receipt }j5 it.µ ,i gal_ 1,`-_ .-k . : >..f 1 $ U.0 o, CITY OF MIAMI BEACH 's} , No. 36.26 0 Cash 0 Credit Card 0 Check# I $ gic.., . • 1 . , 1. I' _ .� 1. :20 I Received of \'k ' ,,` Address gj ti y I I "r+." For :f., J -I' -,-. , • i '-,`. .. r.e..-Y..)1 . ) . �y S '.'1. f ,� r i 'i�� i/°� t T .{`�� t 9 �f ''�} 'p wb t2a w 1 �' � fi.tea F t gI - - " � i_ i`"d.c"' 1�'"..I ,,e' -.' t �`a �^ ,�r � -•.«�1. ti.•a..�*- j. 7 .. "Ir'IP -; is +. w...-- '`+. (THIS INFORMATION MUST BE COMPLETED) • ''%, Offi a of Finance Director By ` ." if ' (',1 I k \ =t 'N -,.' � ., � i .' _ Account Nuwber. - r r Pre arer: - f, 4._° �-- ■ r t t t_ :! '` . 'h XT. t' :.:r P - � �� - Dept: t :� .E � ,