Gil, Michael A.'~ MIAMIBEACH j3v~~~i~
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:
John Kunkel
NAME OF PRINCIPAL/CLIENT:
1398 Bay Drive Miami Beach FL 33141
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 586-3148 kunkelja@bellsouth.net
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN~1CH r~..s.~
CORPORATION, PARTNERSHIP OR TRUST: ~°
A•
n -'~n
;;,
II. SPECIFIC LOBBY ISSUE: _` C.~ :`-r
..`-:
Variance Approval for 1398 Bay Drive "' ~''
E~-=' -`
Issue to be lobbied (Describe in detail): --~ 0 '?'(
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: c-> W `~
_ ~
A) Full Name of Individual/Title ~ B) Any Financial, Familial or Professional Relationship
Planning Department, BOA, City Commission * ~ None
* Unless an issue is legislative In nature, HPB, BOA, Planning Board, and City Commission members are not lobbied outside of a public hearing setting.
./ f
I
~f
N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
r FLAT RATE OR OTHERr
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 lobbvina on a present or cending bid for goods equipment or services or on a
present or vending award for goods, eauioment 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 anelication for a Development Agreement with the Citv or
implication for chance of zoning map designation or chance to the Citv's Future Land Use
Man?
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 reuresenting snot-for-urofit corporation or entity without special 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.
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:
Signature of Principal/Client•
S N
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICA
TION: ~o
~
'
~
'
^ Produced ID ~R
roduced ID l J.
-
- ~.~
Form of Identification Form of Identification z,~
~a ~ c~ .~
o ~ ~
a ~' Personally known (Lobbyist) ^ Personally known (Principal) ~ `~ ~ ~~
~
vim,
~
~ ~ ~~ ~
VII. SIGNATURE AND STAMP OF NOTARY: '*~
~
~ ~ ° ~o`
~
z~ ~ ~ .t
~ State of Florida, County of Miami-Dade
Sworn to and subscribed before me State of Florida, County of Miami-Dade
Sworn an subscri before me .
z ~~
This da 20~~
This f~da
of 20 ~~
~' ° tlO'~o~ _, y
,,~ c,
}
~av. ~ ~
Signature ub' - tate of Florida Signature of ub i N a -State of Florida
Notarization f byisYs signature Notarization of al's signature
~' FOR CLERK'S U E ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid ~~° MCR # ~~r~~l ~ Date Paid ~ Q
Lobbyist Registration Form received and verified by: Entered By:
F:\CLER\;ALL\MARIA-M\LObbyist\LOBBYIST fORM OS.doc ~~ _ f,..yZ, y ~ Revised 12/08/04
.._ ___..
City of Miami BeacFr, 17rJfl Cocvent'san Center [3reve, Miami Beoch, Flori~tx 33134, vrww.rnion3ibeochii,gav
CITY CLERK C;ffi~e C>h~Clerk~minmi`/eacl~H.gav
Tek 3C}5.673.7dt 1 ,Fox: 3fl5.b73.725d
~aBBYlis1~ N~IE: f~ t C h4 c ( C.>i, ~
[ unders#and that no later than October 1st of each year, I must file the following
forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
1 } Lobbyist Expenditure Form
2) Disclosure Form
Failure to file these forms on a timely basis will result in my name being transmitted to the
Miami-0ade County Commission on Ethics and for code violation evaluation.
In addition, once an issue I have registered to lobby on has been resolved, I am required
to immedia#ely notify the City Clerk's Office of lobbyist withdrawal in writing.
~ ~ 1~5~a~
Signs#ure: Date:.