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Michael A. Gil/Margules Properties, Inc.MIAMIBEACH 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 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. Gil Michael A NAME OF LOBBYIST: (Last) (First) (M.I) Bercow, Radell & Fernandez P.A. 200 South Biscayne Blvd., Suite 850 Miami, Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 377-8690 (305) 377-6222 mgil@brzoninglaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Margules Properties, Inc. NAME OF PRINCIPAL/CLIENT: 381 Park Avenue South Suite 1420 New York NY 10016 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (212) 684-7079 ext 19 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: Eric Margules • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Eric Margules II. SPECIFIC LOBBY ISSUE: Redevelopment of 1155 Collins Avenue Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: A) Full Name of Individual/Title Planning Dept., HPB, BOA, Planning Board, City Commission B) Any Financial, Familial or Professional Relationship None IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, ` FLAT RATE OR OTHERf A) LOBBYIST DISCLOSURE: (Required) $ 165 00 per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 165 00 ger hour 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": Q Yes X No Are you lobbvina on a present or pending bid for aoods eauiument or services, or on a Qresent or ~endina award for aoods eauiument or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": QYes X No Are you lobbvina on a uendina aoulication for a Development Agreement with the City or application for chance of zoning map desianat~on or chance to the City's Future Land Ma°? 3) Pursuant to Miami Beach City Code 2-484 (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 snot-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 representing a not for profit corporation or entity without suecial compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1~ 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 FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. , •/~ Signaturebf Lobbyist I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATIO PRINCIPAL IDENTIFICATION: ~ ~ o ~ ^ Produced ID ^ Produced ID ~~ ~ o Form of Identification Form of Identification g~A.~ ~ ~~- s • ~ Personally known (Lobbyist) Personally known (Principal) ~ ~ Z ~~ ~ ~ VII. S TORE AND STAMP OF NOTARY: ~ ~~~ z _ State of or' a, Coun Miami a e State of Florida, u f Miami-Da '~• ~ ~~~'6 Swor d s bscnb f e Sworn~b i f r e ~~ ~y~.~ This ay of This ay T ure of Public Notary -State lorida Sig ur Public Notary -State lorida N.,tnri~ntinn of 1 nhhviet's signature tarization of Principal's signature FOR CLE EyONLY ~ Annual Registration fee: [ ~~ es [ ] No Amount P ' ~_ MCR # ~~~ r Date Paid ~l .~ G Lobbyist Registration Form received and verified by: Entered By: F:\CLER\$ALL\MARIA-M\LObbyist\LOBBYIST FORM OS.doc Revised 12J08/04 ~L " /