Affidavit (07/09/2001)
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CITY Of MIAMI BEACH
OFFICE OF THE CITY CLERK
1700 Convention Center Drive
Miami Beach, FL 33139
cityclerk((i)ci.miami-beach. f1.us
AFFIDAVIT
"
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
DEQSION OF ANY COMMISSIONER; ANY ACTION, DECISION, 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 1HE ENTIRE DECISION-MAKING PROCESS ON SUCH ACTION,
DECISION OR RECOMMENDATION THAT FORESEEABL Y WILL BE HEARD OR REVIEWED BY THE CITY COMMISSION,
OR A CITY BOARD OR COMMmEE. THE TERM SPECIFICALLY INCLUDES THE PRINCIPAL AS WELL AS ANY AGENT,
ATTORNEY, OFFICER OR EMPLOYEE OF A PRINCIPAL, REC'ARDLESS OF WHETHER SUCH LOBBYING ACTIvmES
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."
1) Lobbyist Name: Bercow Jeffrey
Last Name First Name Middle Initial
Business Phone (3llS) 177 - t:; n 0
Message Phone (_)
Business Address:
200 S. Biscayne Boulevard
No. Street
Florida
State
33131
Zip Code
850
Suite
Miami
City
Email Address:
2) Principal Retained by: Coolidge - South Markets Equities, L.P.
670 white Plains Road 305
Ii' different from above Street Suite
Scarsdale New York 10583
City State Zip Code
(3) 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 to Historic Preservation
Board Application
4, Identify each individual (Commissioners, Boa, d, Committee, Authority member or City staff)
to be lobbied: Historic Preservi'lt i on ROi'lrn r ri ty !';t"ff
5. The subject matter in number three (3) above is to be considered atthe meeting of
(Identify each entity or individual):
on
on
on
Preservation Boarden August
on
on
.2000
,2000
,2000
1 4 . 2001
.2000
.2000
o The City Commission
o City Commission Subcommittee
o City Staff
IH City Board or Committee Historic
o Personnel
o Identify Others
6. State the extent of any business, financial, familial, professional or other relationship which
exists with any individual identified in number (4) above:
ON JULY 1sT OF EACH YEAR, EACH LOBB '(ST SHALL SUBMIT TO THE CITY CLERK A
SIGNED STATEMENT UNDER OATH, USUNG A LOBBYING EXPENDITURES IN THE
CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR.
I do solemnly swear that all of the foregoing fa
am familiar with the provisions tat din
amended, and all reporting r ui ts.
Signature of Lobbyist:
( Personally known
o Produced ID
are true and correct and that I have read or
n 2.482 0 the Miami Beach Oty Code as
Identify
o Did take an oath, or
J( Did not take an oath
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This ~ day of ~ 20011. c::::.
---ll-'. (l~ \rJ'~
~,~ CRISTINA 0, GONZALEZNotar; ,?r Depu Cle " , ~
..... .b~'<;r. COMMISION * CC 727273
I-~ - iIl(PlmMAR23,2002 .."
~o1,,-!f"Tl..tlii~'flfirYt;stamp or type as commissioned
FOR CLEFK'~ USE ONLY
Registration: [] ACCEPTED [] REJECTED DATE:
If rejected, state reason:
Registration fee paid: [ ] Yes [ ] No [] Not-for-Profit Organization
[ ] Cash [' ] Check MeR #
DATA ENTRY DATE:
.2000
ENTERED BY: