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Michael A. Gilm MIAMIBEACH City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATIOI~I 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: 852 Collins Acquisitions, LLC NAME OF PRINCIPAL/CLIENT: 25 West 39th Street New York NY 10018 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (212) 529-7415 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: Joseph J. Sitt • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Joseph J. Sitt II. SPECIFIC LOBBY ISSUE: Redevelopment of 852 Collins Avenue Issue to be lobbied (Describe in detail): .:,, ,:.r~ rt r;,,~~a*~ III. CITY AGENCIES/INDIVIDUALS TO BE LOBBI~p ~3.t!1f , , ``',, :,yF+~+ ~,~~ r A) Full Name of Individual/Title ~ ];),Any Fir~dnl~la~, Familial or Professional Relationship ~ ,~ ; ,~ „ Planning Dept., HPB, BOA, Planning Board, City Commission NFane` k: ~~ ~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT R.4 TE OR OTHERj. 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 uendina bid for goods equipment or services or on a present or uendina 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": uYes X No_: Are you lobbvina on a uendina aoulication for a Develoument Agreement with the City or apalication for chance of zoning may designation or chance to the City's Future Land Use Mau? 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 reuresenting anot-for-profit 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. - /~~~~~'E'~-mil 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: VI. LOBBYIST IDENTIFICATION: Produced ID m 3g .~ ~~", VII. ci e ~ ~ State w Swori This ~ PRINCIPAL IDENTIFICATION: Produced ID Form of Identification ~~Ha~e.n~,,,,~~ Personally known (Lobbyist) ,}~ ~~ • • • ~ SIGNATURE AND STAMP OF NEB)' ~ •(PF' Signature of Public Notary - ~ Notarization of Lobbyists Form of Identification ally known (Principal);, ade s ~ ~~ ~ ,~ka~g 8f Florida, County of Miami-Dade '- J •.. ~~SGO`? S r~i and subscribed before me ~~'•,,~~ S ... a~day of Mum , 20~ ,,,,,rq~'oF , ,,,. of_ of Flo Si nature of Public N - g of State of Florida nature Notarization of Principal's signature ~/ FOR CLERK'S USE ONLY ~} -" Z ~, Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR #~ / ~~ Date Paid ~~ ~ ~ I Lobbyist Registration Form received and verified by: ntered By: • F:\CLER\$ALL\MARIA-M\LObbyist\LOBBYIST fORM OS.doc Revised 12/08/04 City a# Miami Beach, 1 th`~ ~©r,4er~tian +~cnter ~Jrve, tJ~icmi BeccY~, .r1a,-ica 33 i 3a, vrwti.'.mia~~~b~oc'~fl,go~: CITt` ~iLEPi~ ©ffice ~;i•rCl~rk~mcmiE~eachfi.gov TeE 3u3.b73,7-'. i 1 , Fcx~ 3~r4.b73.~ 25d LOBBIf'1ST NA141E: ~ ( C ~ ~ ~ I understand tl;ot no later than flttober i st of each Rear, I must file the fallowing forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's C?ffice for all active lobbying 'sssues. I ~ Lobbyist Expenditure Form 2j Disclosure Form Failure to file these forms on a timely basis will result in my name being Transmitted to the Miami-Dade County Commission on Ethics and for code violation evaluation. In addition, once an issue f have registered to lobby on has been resolved, ! am required to immediately notify the City Clerk's C)ffice of lobbyist withdrawal in writing. ' ,~~~ ~, ~1 s 1 ~ ~ Signature: Date: ~_. _. ~..