Sunset Three 12/06/2001
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CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Ct'nter Drive
Miami Beach, FL 33139
citycferk@lci,miami-beach.f1,us
AFFIDAVIT
. '.
LOBBYIST MEANS ALL PERSONS EMPLOYED OR RETAINED, WHETHER PAID OR NOT, BY A PRINOPAL WHO SEEKS
TO ENCOURAGE THE PASSAGE, DEFEAT OR MODIFICATION OF ANY ORDINANCE, RESOLUTION, ACTlON OR
DEOSION OF ANY COMMISSIONER; ANY ACTlON, DEOSION, RECOMMENDATION OF ANY CITY BOARD OR
COMMmEE; OR ANY ACTION, DECISION OR RECOMMENDATION OF ANY PERSONNEL DEFINED IN ANY MANNER
IN THIS SECTION, 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 AGENT,
ATTORNEY, OFFICER OR EMPLOYEE OF A PRINCIPAL, RE(t\RDLESS OF WHETHER SUCH LOBBYING ACTIVrnES
FALL WITHIN THE NORMAL SCOPE OF EMPLOYMENT OF SUCH AGENT, ATTORNEY, OFFICER OR EMPLOYEE. EACH
PERSON WHO WITHDRAWS AS A LOBBYIST IS REQUIRED TO FILE A ~CERTIFICATE OF WITHDRAWAL.H
1) Lobbyist Name: Bercow Jeffrey
Last Name First Name Middle Initial
Business Phone C3..a.s) 177 - f\ 7.? 0
Message Phone L)
Business Address:
200 S. Biscayne Boulevard
No. Street
Florida
Miami
City
Erriail Address:
. .-..~ .,....' .
{, ;;:'i,"(;,-,'''. i !' .-:. ':
2) Prin~'Retain~~bY.::.
t ' ".- ': ':I[
Sunset Three-~??.I.:j;.:C:_"i, 1800
If different from above
Miami
State
33131
Zip Code
850
Suite
City
Sunset Harbor Drive
Street
Florida
. State
Suite
33139 '
Zip Code
(a) If a corporation, partnership, or trust, identify and provide the address for the chief
officer, partner, beneficiary or interests.
3)
Subject Matter (Describe in Detail):
Modification
Approval
4, Identify each individual (Commissioners, Board, Committee, Authority member or City staff)
to be lobbied: City Staff. We will not communicate with members of the
Planning Board prior to the public hearina since t]-u"y ..,i 11 ,....u~ ~,.,
this application while acting in their quasi-judicial capacity.
5'(/0 Y,
l
S. The subject matter in number three (3) above is to be considered at the meeting of
(Identify each entity or individual):
0 The City Commission on ,2000
0 City Commission Subcommittee on .2000
0 City Staff on ,2000
'm- City Board or Committee Planning Board on Jan. 22 . 20Qjl
0 Personnel on .2000
0 Identify Others on .2000
6, State the extent of any business, financial, familial, professional or other relationship which
exists with any individual identified in number (4) above: NODe
ON JULY 1sT OF EACH YEAR, EACH LOBBYST SHALL SUBMIT TO THE CITY CLERK A
SIGNED STATEMENT UNDER OATH, USTING A LOBBYING EXPENDITURES IN THE
CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR.
I do solemnly swear that all of the foregoing fa are true and correct and that I have read or
am familiar with the provision ntained in e 'on 2-482 of the Miami Beach Oty Code as
amended, and all reporting r qu r ts.
Signature of Lobbyist:
X Personally known
Q Produced ID
Identify
USA C, BIIOOKi,
MY COMMISSION' CC 856829
EXPIRES: July 20, 2003.' .
__~P.mllc_
o Did take an oath, or
X Did not take an oath
State of Florida, County of Miami-Dade 2 I
Sworn to and sUbscri~ before me 00
This .b..fl-.. day of -e.c. ' . 2~
~.~
Notary or Deputy Clerk
---L~~ c"eYDO~S . oOu
If Notary, print, stamp or type as commissioned
FOR CLERK'~ USE ONLY
I r 7 (O;;Y
I '
Registration:
[ ] REJECTED DATE:
MCR#
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ENTERED BY:
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