Michael A. Gil/Xenia 2206, LLCm 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 teen "Lobbyists" has specific exclusions. Please refer to Ordnance 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:
Xenia 2206, LLC
NAME OF PRINCIPALJCLIENT:
119 Washinoton Avenue, Suite 101 Miami Beach FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786) 443-6395 dg@nereo.it
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: Daniel Goldstein
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: Renzo Rangoni, Renato Rangoni
II. SPECIFIC LOBBY ISSUE:
Redevelopment of 2206 Park Avenue and 427 22 Street - COA, Variance Approvals
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
Planning Dept., HPB, BOA, Planning Board, City Commission * None
~~1:~~~` ~~r~':~~~1:~ }~l
* Unless an issue is legislative in nature, HPB, BOA, Planning Board, and City Commission members ar~,~ty6Abi22i"outside of a public hearing setting.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERt
A) LOBBYIST DISCLOSURE: (Required) $ 220.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 220.00 per 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":
^ Yes X No: Are you lobbying on a present or pending bid for goods, equipment or services, or on a
present or pending award for goods, equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes X No: Are you lobbying on a pending application for a Development Agreement with the City or
application for change of zoning map designation or change to the City's Future Land Use
MaD?
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 anot-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 reioresentina anot-for-profit corporation or entity without special comipensation
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.
Signature of 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:
ature of Principal/C
o ~°M-,WI. LOBBYIST IDENTIFICATION:
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^ Produced ID
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SIGNATURE AND STAMP OF NOTARY:
,~~bO'd~ to of FI ida, County of Miami- a e
~"~ orn an ubscrib_ed be re e
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Sig ure ublic Nota a of Flori
Notarization of Lobbyists gnature
Annual Registration fee: [ ]Yes [ ] No
PRINCIPAL IDENTIFICATION:
^ Produced ID
~~ Form of Identification
t~Fersonally known (Pr ~ "~ "tea,,,, 09CAR M BARRAMEDA
.. . ~? Notary Public • State of Florlde
_ ~ • • MY Corn~nission Exphet Feb 22.2011
`~ ' ~ `' Commissloe ;r DO 630294
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''''„~.~,~~• BondedThrgghNayoadNolaryAtm.
State of Florida, County
Sworn and subscribed be ore me
This o~i ~Cday of T 20~~
Signature of Public No ry - tate of Florida
Notarization of Pri ipal signature
FOR CLERK'S USE ONLY '7(~/~S
Amount Paid _ MCR #
Paid (Ql ~~ I D
Lobbyist Registration Form received and verified by: Entered By: ~ ,~i~~-~'~ y`"~
F:\CLER\$ALL\MARIA-M\tobbyist\LOBBYISTfORM OS.doc ~~ised 12/08/04
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Lily of Miattti Saatlt, 1700 Convey>tion Center Drive, Miami Beach, i=koric~a 33134, www.momibeochfl.~av
CIiY +uLERK Of~i~e CityClerkQmFami6eac?~fi.c~ov
Te(: 3Q5.573,741 1 ,Fax: 305.b73.7254
I`OesY~sr r,~f: ~ ~ c~h ~ ~, y ~ ~
I understand tha# no later than October 1st olf each year, I must file the following
forms, pursuant to Section 2-4$5 of the Miami Beach City Code, with the City Clerk's
Office far all active lobbying issues.
1 ~ Lobbyist Expenditure form
2~ Disclosure Form
Failure to file these forms on a timely basis will result in my Home being transmitted to the
Miami-bode County Commission on Ethics and for code violation evaluation.
(n addition, ante an issue I have registered to lobby on has been resolved, I am required
to immediately notify the City Clerk's C?ffice of lobbyist withdrawal in writing.
Signature: Date: