Monika Entin - Alan Lieberman Mi 3, ilvA .�1"l,c, �, Ctrtiv)6
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City of Miami Beach Office of the City Clerk 4 ;
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
2015 NOY 1y ;t10:
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage,cdefeat ors
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.
Entin Monika
NAME OF LOBBYIST: (Last) (First) (M.I)
Bercow Radell&Fernandez, PLLC, 200 South Biscayne Boulevard, Suite 850, Miami, FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-377-6237 305-377-6222 MEntin(a1BRZoningLaw.corn
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes: address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Alan Lieberman
NAME OF PRINCIPAL/CLIENT:
Catalina Dorset, LLC 1720-1756 Collins Avenue, Miami Beach FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 531-5831 (305) 535-9665 c/o Chris.rollins(a,southbeacharoup.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: 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 the Historic Preservation Board, Design Review
Board, Planning Board, Board of Adjustment, Land Use Development Committee, City Commission, and any City Workshops or
Committees i necessa relatin• to the .ro.ert located at 1720-1756 Collins Avenue Miami Beach Florida.
Issue to be lobbied(Describe in detail):
Ill. 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 _
Staff for the Planning Department, Building Department, None. X
Public Works and City administration, PB, HPB, BOA, None. X
-
City Commission, and Mayor 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
None.
None.
None.
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Formrevised 5-30-2012.doc a
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) $400.00 per hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $400.00 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 XNo: Are you lobbyina on a present or pending bid for aoods.eauipment or services.or on a present or pending
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 XNo: Are you lobbying on a pendina application for a Development Aareement with the City or application for
chanae of zonina 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.
_Yes X No: 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,
1 OATH. LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATION RECEIVED. IN THE CITY OF MIAMI BEACH
EQH .._ . ►_ . 1 Z 1_. A _u L. ._ • -1_4E2il_J VEN IF THERE HAVE BEEN NO
EXPENDITURES OR • ii ' k 1 • ► • : ► • : ' • : k ' ,:1 • .
lil -
1 -41(
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are true and corr-_ -nd that I have read o am familiar with the provisions contained
in Section 2-482 of the Miami Beach City Code and all repo in! equirements.
Signature of Lobbyist: A... ;,‘
Signature of Principal/Client: A –
N
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1 v- " „lir/
VI. LOBBYIST IDENTIFICATION: `•••:°;p_ PRINCIPAL IDENTIFICATION: 0 LL• �, r o
Produced ID '"PP , >'' Produced ID w o
z (J) 2 ti
Form of Identification I m Z Form of Identificati N cn
• �c o 2 W r
o c7 ~ 2 3
Personally known(Lobbyist) 3 CO ersonally known (Principal) re o X
H m Q V 2
VII. SIGNATURE AND STAMP OF NOTARY: _ ..,00.::,,g.., n
State of Florida, County of Miami-Dade o d . Z State of Florida,County of Miami-Dade q.' :,.a
Sworn to .nd subscribed before me « c, ,, a Sworn and subscribed before me `°;►•,;:t
This .0...,.0: of ,2015 N o ° This _day of i_4 �,. y ' 2015 01 i ra
,A.... _,/ ' • ...4,4 42.• 0 _i 1 ' U(4(4._.
Sign. pre of "Mc Notary–State of Florida •ignature of P •lic Nota –State of Florida
Nota ization o obbvist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY 1
Annual Registration fee: [ ]Yes[ No Amount Paid$ -5 S 0 MCR# LA 0'&30 k Date Paid l 1/let 1 1'�
Lobbyist Registration Form received and verified by: CQY'1v`-`- I
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 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 suspended • lobbying until all fines are paid, unless the fine has been
appealed to the ► •-mi-Dade Coun ommission on Ethics and Public Trust.
Signat re: Dat .
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Formrevised 5-30-2012.doc
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. CORPORATION
If the property which is the subject of the application is owned or leased by a CORPORATION, list ALL of the
stockholders,and the percentage of stock owned by each. Where the stockholders consist of another corporation(s),
trustee(s), partnership(s)or other similar entity, further disclosure shall be required which discloses the identity of the
individual(s)(natural persons)having the ultimate ownership interest in the entity.*
Catalina Dorset,LLC- 1720-1756 Collins Avenue, Miami Beach,Florida
CORPORATION NAME
NAME AND ADDRESS %OF STOCK
Alan Lieberman-Member 50%
19955 NE 38th Court, Unit 2904
Aventura, FL 33180
Nathan Lieberman 50%
1680 Meridian Ave, Unit 102
Miami Beach, FL 33139
PCCO, Inc.- 1680 Meridian Ave, Unit 102,Miami Beach, Florida
CORPORATION NAME
NAME AND ADDRESS %OF STOCK
Alan Lieberman-Member 100%
19955 NE 38th Court, Unit 2904
Aventura, FL 33180
IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S) AND EACH
INDIVIDUAL STOCKHOLDER'S NAME,ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE
PAGE.
NOTE: Notarized signature required on page 8
6
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CITY HALL CASHIER OFFI - k'':''
1700 CONVENTION CNTR DR
MIAMI BEACH, FL 33139
11/19/2015
10:03:41
CREDIT CARD
AMEX SALE
CARD# -
-.lmomm
Chip Card: X' ' ' '• '5230
Chip Card AID: AMERICAN EXPRESS
ATC: A000000025010801 City of Miami Beach-Florida
TC: 0016 Finance Department
INVOICE E394CCBE3909FB00
SEQ#: 0005 1 City Hall
Batch#: 0005 1532313-1 11/19/2015 BR1 T137
001672 Thu Nov19,2015 COLERKAM MCRnC#tySClerk
Approval Code: 6 $700.00 MCRC• LERK Method: 884608 * MCR#: 408306
Mode: Chip Read
Issuer 1 ITEM(S): TOTAL: $700,00
SALE AMOUNT Credit Car PAID $700.00
$700.00
Have a nice day!
CUSTOMER COPY