Jeffrey Bercow/The Congress GpMIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means ali persons employed or retained, whether paid or not, by a principal who seeks to entourage the passage, defeat
or modification of any ordinance, resolution, action or deddon of any mmmisdm~, any action, dedsion, re~mme~dat~on of Ihe
Oty Manager or any db/board or committee; or any action, derision or recommendation of any city personnel during the time
pedod of the entire derision-making process on such action, decision or re~omme~a~on that foreseeably will be heard or reviewed
by the db/commission, or a db/board or omm~tee. The term spedfically indudas the principal as well as any employee ~
~iobbying activil~s. The term "Lobl~/i~' has spedflc e~dudeas. Please refer to Ordnance 2004-3435.
Bercow f Jeffrey
NAME OF LOBBYIST: (Last) (l~t)
BUSINESS NAHE AND ADDRESS (Numbe~and Street) (Ot~) -
..... 305-37.7-6220 305-377-,622,2
~ t:LEPI:tONE NONBER: FAX NUI~ER:
'
(stae) (z~p Code)
i bercow@brzonin~law, ... com
L LOBBYIST RETAZNED BY:
The Congress Group
NAME OF PI~NQPAI.~C'LTENT:
The Congress Group
33 Arch Street, Boston, MA 02110
BUS~N~.~$ NAME ~ ADDRESS (Number and Street) (Oty)
(s~t~) ~p oxte)
NAME OF
HOLDing, mR~'TLY O~ mDmECn.Y,
PE~NS
~~ON~ PA~HIP OR ~U~:
~. SPECiFiC LOBBY ISSUE=
~Issue to be lobbied (Desuibe in detail):
ZZZ, CZTY AGENa:ESIZND~VZDUALS TO BE LOBATED:
A) Full Name of Znclividual/T'Wle
B) Any Financial, Familial or Professional Relationship
A) LOBBYZST DISCLOSURE: (Required), $ 4 7 5,, per hour
B) ~N~P~ P~~ (OF tOS~ ~~ON): (~~
~e ~llowing in~m~on m~ ~ a~~:
DZSC:LOSURE OF TERHS AND AHOUNTS OF LOBBYZST COHPENSAll:ON (DZSCLOSE WHETHER
$4.75 per ho~.r , ,,
1)
Pursuant to Miami Beach CRy COde SecUon 2-488 Entitled "Prohibited Campaign ContrtbuUons By Lobbyists
On Procurement Lssues":
[] Yes g, Nm. Are you Iobbvin. mt a .resent or eendirm bid for .om~. eaaimaeae or services, or mt a
2) Pursuant to Hiami Beach City Code 2-490 Entitled "Prohibited Campaign Contdbu~ns By Lobbyists On Real
DYes ~2'No: Are you lobbvin, on a .endin. aoolleatkm for a Develo~ ~ a~th ~ C'~y or
aoolicaUon for chance of zonin, mae clatmlebn er chanae to the ~tv's Future .Land Use
Mm)?
3)
Pursuant to Miami Beach City Code 2-484 (h) Any person (except trinse exempt from the definition of
"lobbyist" as set forth in SecUon 2-481 above) who only appears as a represenlaUve of a not-for-profit
corporation or enUty without special compensation or reimbursement for the appearance, wtmltmr direct, or
indirect, to express support or or opposition to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registraUon fees..
Yes ~1;~10: Are vo. reeraeati.a a .ot-fer-erofitcommlltial or er reimtmmement..
V. SIGNATURE UNDER OATH:
,,,:,,:,,,. Sworn s befom ..me
-'~"~':'~a.~'.'% This ,, [~ d~_~20~:
~~n ~ ~b~s ~um
ON OCTOBER Is~ OF EACH YEAR, EACH LOBBYZST SHALL SUBMXT TO_THE ~ CLERK A SXGNED
STATEMENT UNDER OATH~ I.Z~ LOBBYXNG EXPE~E]~RES, ~/WELL AS COMPENSATZON
~ED, ZN THE CITY OF HZAMX BEACH FOR THE ~ZNG ~AR YEAR. A STATEMENT
SHALL BE FXLED EVEN 31: THERE HAVE BEEN NO ~~TURES/OI~COMPENSAT~QN DURING THE
I do mlemnly ~t~r that all o~ the for~otn§ fact~ ~re tree,lind correct ~o~h~t I ~ re~ or ~m
familiar ~th the m-o~siom contained in ~Se~on :~-482 o~ tM J~m! i~c~tl~y-~ ~d~l reporUng
Signature of Lobbyist:
Signature of Prindpal/alenb_ ~ ~
,.,.,o ~ m' "" ~--~Zclen ~--~~nn
a Personally known (erlacipal)
Sta~e of Florida, County or Miaml-Dade
Swom and subscribed before me
Tins 2-'a- day or
~n of pdacipars signatum
ONLY
Annual Registration fee: [ ~'] Yes [ ] No Amounl~aij;I ..~,') -O0 .