General Real Estate Corp.
ta
~
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 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 employee engaged in lobbying activities. The term
ftLobbyistsn has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST:
Bercow
(Last)
Jeffrev
(First)
(M.I.) DATE QUALIFIED AS LOBBYIST
200 S. Biscavne Boulevard Su~e 850
BUSINESS ADDRESS: (Number and Street)
Miami
(City)
Florida
(State)
33131
(Zip Code)
305-374-5300
TELEPHONE NUMBER:
305-377-6222
FAX NUMBER:
EMAIL:
I. LOBBYIST RETAINED BY:
General Real Estate CorDoration
NAME OF PRINCIPAUCLlENT:
8500 SW 8th Street Suite 228
BUSINESS ADDRESS: (Number and Street)
Miami Florida
(City) (State)
33144
(Zip Code)
305-262-6533
TELEPHONE NUMBER:
305-262-1703
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 OF BENEFICIARY: James Dorsy
? LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Altos Del Mar Prooerties
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Indivldualrritle BI Relationship
City Staff None
Mavor None
City Commissioners None
iv. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $420.00/hourlv basis
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $420.00/hourlv basis
~ Yes ~ No: Are YOU reDresentinD a not-for-Drofit corDoration or entity without sDecial comDensation or
reimbursement. Pursuant to Ordinance No. 2004-3435.
1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions BY Lobbvists On Procurement Issues":
~ Yes ~ No: Are YOU 10bbyinD on a Dresent or DendinD bid for Doods. eDuiDment or services. or on a
Dresent or DendinD award for Doods. eGuiDment or service?
2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach Otv Code Chaoter 2 Article VII Division 5
thereof Entitled "Camoaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions BY LobbYists On Real Estate Develooment Issues":
iliYes ~ No: Are YOU lobbyinG on a endinG aDDlication for a DeyeloDment AGreement with the City or
aDDlication for chanDe of zoninG maD desiGnation or chanDe to the City's Future Land Use MaD?
V, SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, A WELL MPENSATION RECEIVED,
IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CAL A . A ENT SHAL E FILED
EVEN IF THERE HAVE BEEN NO EXPENDITURES OR CO E 5 D EPO NG PERIOD.
Signature of Lobbyist:
C)
:::0
rn
f1'-, ()
""""'-" CD rn
::::>~
-0 <
P. 0 m
-r; 0
U1
c-:l U1
('T'\
I do solemnly swear that all of the ~
am familiar with the provisions co in
reporting requirements.
Signature of Principal/Client:
VI.
Produced ID
Produced ID
Form of Identification
Form of Identification
~ Personally known (Lobbyist)
Personally known (Princip
ANAMARIA GUERRA.VERA
MY COMMISSION # DO 199055
EXPIRES: August 28, 2005
Bonded Thru Notary Public Underwriters
VII. SIGNATURE AND STAMP OF NOTARY:
- State of Florida
t's signature
State of Florida, County of Mia -
Sworn and subscribed before me . J
This ~ day of mV<j , 20 D I
~~~~
Sign~ ublic Notary - State of Florida
Notarization of Principal's signature
State of Florida, County of Miami-Dade
Sworn SUbscribeJ.tj7re m,e ,l
This day of 202. T
S' -( y;' - \) If-
1 First Revision - 05-17-02