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Monika Entin - Mango's Tropical Cafe ciao Ct ►7::)Hve__ MIAMI BEACH City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 2°16 JUL I I AN II' 55 LOBBYIST REGISTRATION FORM i i L _ ;, 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. 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(aBRZoninaLaw.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: David Wallack, Chief Executive Officer NAME OF PRINCIPAUCLIENT: Mango's Tropical Café 900 Ocean Drive Miami Beach FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 673-4422 dw(dmanaos.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, if necessaru. relatina to the propertu located at 900 Ocean 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 Staff for the Planning Department, Building Department, None. X Public Works and City administration, PB, HPB, BOA, None. X DRB, 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. C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)$425.00 per hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $425.00 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 lobbvina on a present or nendina bid for aoods.eauipment or services. or on a present or pending award for aoods.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 lobbvina on a nendina application for a Develooment 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, shalt 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 OATH. LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATION RECEIVED. IN THE CITY OF MIAMI BEACH EQE THE PRECEDING CALENDAR YEAR. A STATEMENT _ii_ :_ __! ► IF THERE HAVE BEEN NO EXPENDITURES OR • u •_■ _ • . !Si ! . ■ . _ :_• • : ► �•_: • I Signature of Lobbyist I do solemnly swear that all of the foregoing facts are de and correct and tha- have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and : I reportin• requirement Signature of Lobbyist: ' Signature of Principal/Client: �_ A , VI. LOBBYIST IDENTIFICATION: °r, PRINCIPAL IDENTIFICATION: ' or,I�JO, :(V <- 11 4 49p ••, , .- - ""111111 ` C- _Produced ID m, _Produced ID ;t o Form of Identification 'Z. Form of Identification i 2 cc ,. 0 s z Er -I f Personally known(Lobbyist) ■ CO ersonay nown( rncpa) ) x n o e .S 3 c m VII. SIGNATURE AND STAMP OF NOTARY: ? ► -. m. { r it N N m ' .1 2 d o D State of Florida, County of Miami-Dade o Z State of Florida, County of Miami-Dade N s • Sworn to and subscribe ore me m -, ° > Sworn and subscribqd b fore me 4 ^' ° s ,. 4 This •ay of 1 2016 . N o This �� day of �u 2016 r_ . . °° Sig ature '�+ I^� otary—State of Florida Signature of Tic 'otary—State of Florida Notarizati..•S•fLobbyist's signature No :rization 1 Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes ]No Amount Paid$ $5a MCR# Lilo`?3 7 Date Paid 7/y/A. Lobbyist Registration Form receiv and verified by: 74.500 S4]vcc4� l MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeach0.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 from lobbying until all fines are paid, unless the fine has been appealed to the M' i- ade my Commission on Ethics and Public Trust. 1 ( M0 Signature: ate: C:\Users\clerhatlWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc Detail by Entity Name Page 1 of 2 FLORIDA DEPARTMENT O SETA E 1V1.510 N 011' CO R!'O./Off 1:0'N:S Detail by Entity Name Florida Limited Liability Company MANGO'S TROPICAL CAFE, LLC Filing Information Document Number L13000029426 FEI/EIN Number 65-0206434 Date Filed 02/25/2013 Effective Date 05/09/1990 State FL Status ACTIVE Last Event CONVERSION Event Date Filed 02/25/2013 Event Effective Date NONE Principal Address 900 OCEAN DRIVE MIAMI BEACH, FL 33139 Mailing Address 900 OCEAN DRIVE MIAMI BEACH, FL 33139 Registered Agent Name &Address WALLACK, DAVID P 900 OCEAN DRIVE MIAMI BEACH, FL 33139 Authorized Person(s) Detail Name & Address Title MGR WALLACK, DAVID P 900 OCEAN DRIVE MIAMI BEACH, FL 33139 Annual Reports Report Year Filed Date 2014 04/18/2014 2015 04/24/2015 http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 7/8/2016 Detail by Entity Name Page 2 of 2 2016 05/23/2016 Document Images 05/23/2016 --ANNUAL REPORT View image in PDF format 04/24/2015 --ANNUAL REPORT View image in PDF format 04/18/2014 --ANNUAL REPORT View image in PDF format 02/25/2013 -- Florida Limited Liability View image in PDF format Copyright©and Privacy Policies State of Florida,Department of State http://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entity... 7/8/2016 - Miscellaneous Cash.Receipt - CITY OF MIAMI BEACH .. .4 1 0 7 . No. 0 Cash 0 Credit Card Check# L� I `1 U $ —7 0 0 °C) t`7` 11 20 • ( City of Mian I�®ft, ed of 1 V 1 10)1 i L C.-�114-i A + M !(\ ,a& i L AC.c�r/c+' Miscellaneoial9fCFt fi00 c 1 )',c r 0-,Ivs l 1" a�(`'+ ?�� �vt..u`E i t 000288-0019?Inc! 711,J2 ; t 1`56 1,1 ( k' T - - MCR OPEN Payment Amount: 700,00 mcr410732 (THIS INFORMATION MUST BE COMPLETED) Office-of Finance Director. . By Account Number: OH _ 0ao0 3;DCf LIt')L) . 00'- 3c,7 ' 36.5- Qa- '-- tx� a t tt Preparers ? 5 b..a 5A M-'i-3 Dept. 1 EXT: G) / f } in C7 —1 C./ O F is - y C-,T rC+Q N 3 CCD Cn O i 3 Cg� Z7 CD T CD CS CD 0 r--, _- T r D _ R . : , w 70 O CD I n O C Z D O m Z � _4.- ,g CD m - I--I Z CD 0 0 T� _ - 9. !- I i I p - 70 . n t T7 "0 0 ...-1.,...-1....-1.,i p CD 0 I 1 CO O T D CT r+.< 3 •O l' S al.( , i N O i t J ; CD O T .- °' , 1 k 1 14 1 .-- — CO $ f p X � o 0 0 0 0 o cn O f o 0 0 O v !� 0 O 0 O ' p O O O 0 O 3