Michael A. Gil/Elena Feldenkreism MIAMIBEACH ~~ ~s~,~Q~
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 prindpal who seeks to en~urage the passage, defeat
or modification of any ordinance, resolution, action or derision of any commissioner; any action, derision, recommendation of the
City Manager or any rity board or committee; or any action, derision or recommendation of any aty personnel during the lime
period of the entire derision-making process on such action, derision or recommendation that foreseeably will be heard or reviewed
by the clty commission, or a aty board or corr-mittee. The term sperifically includes the prinripal as well as any employee engaged
in lobbying activities. The berm "lobbyists' has spealic exclusions. Please r+eFer to Ordinance 2004-3435.
Gil Michael A.
NAME OF LOBBYIST: (Last) (Frst) (M.I)
Bartow, Radell & Fernandez P.A. 200 South Biscayne Blvd., Suite 850 Miami, Rorida 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:
LOBBYIST RETAINED BY:
Elena Fetdenkreis
NAME OF PRINCIPAL/CLIENT:
5222-5224 North Bay Road Miami Beach FL 33140
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 873-1310
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
out this section if prindpal 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 SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Variance Approval for 5222-5224 North Bay Road
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/T"itle B) Any Finandal, Familial or Professional Relationship
Planning Department, BOA, Gty Commission * None
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~- f-~n~, Boaz
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* Unless an issue is legislative in nature, HPB, BOA, Planning Board, and City Commission members are not bbbied outsid33e of a pu~caring setting.
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERx
A) LOBBYIST DISCLOSURE: (Required) ~ 250 00 Der hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 250.00 oer hour
The following information must be answered:
1) Pursuant to Miami Beach Gty Code Section 2-4>~ Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^ Yes X No' Are ~u lobbving_on a uresent or oendina~i fir g~gquionrent a" s~xvices• or on a
rq e~1t_orina award for Lr!'nment or service?
2) Pursuant to Miami Beach qty Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Devebpment Issues":
^Yes X No' Are 1L~ lobbring~ng aooliration for a Devebuntent /Rgreernent witfi the City or
grL.~l'~~,rr for dtartrae of zoning map dasianation or chance to the Citv's Future Land Use
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 281 above) who only appears as a representative of anot-for-profit
corporation or entity without spedal compensation or reimbursement for the appearance, wF-ether direct, or
indirect, to express support of or opposition to any item, shall register with the deck as required by this
section but, shall not be required to pay any registration fees..
^ Yes X No• Are you reoresentina coot-for-urofit cornoration or entity witlrout I oanoensation
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 qty Code and all reporting
requirements. ~ ~ - „
Signature of lobbyist:
Signature of Principal/gient: -~
VI. LOBBYIST IDENTIFIGTION:
PRINCIPAL IDENTIFIGTION:
^ ProduoedID
Form of Identfication
Personally known (Lobbyist)
w o ° VII. SIGNATURE AND STAMP OF NOTARY:
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a ~.~Q
a o State of Florida, County of Miami-Dade
~ ~ ~ a Swom to~ subscri re me
i ~ ~ w This ~ day of JVY I.P ,. 20~
y ®~ Si ature bli Nota State of Florida
~; S 9 rY -
~aw. ~" N rizati of Lobbyist's signature
^ Produced ID
Form of Identification
~rsonaly known (Prindpal)
R
~g~
N~
State of Florida, County of Miami-Dade ~
Swom_aryd su me
This ~tN y of 20 ~~
Signature otary - of Horida
Notarization of Principal's signature
FOR CLERK'S USE ONLY ~~~ ~~/' ~ ~ ~ C~
Annual Registration fee: [ ]Yes [ ] No Arnount Paid „~~ MCR ~b Date Paid
Lobbyist Registration Form received and verified by: ___ En By:
F:\CLER\;ALL\MARIA-M\LObbyfst\LOBBYIST FORM OS.dot _ T Revised 12/08/04
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Cit~ra# iMliami Beach, 174 ~..anventitsn Ce+~ter give. Miami Beacia, F~cP~'c s"3?39; www.miomi~essch£i.n~v
C€TY ~lL?K ~Jffice Ci^rClerk~miami~ecc~Fi.gav
i e3: 305.6?3.7d T ? , fox; 305.63.7254
6.GIBBYIST NAME : V ~ ~ ~-~o..~ ` ~ ~ \
I understand that no later than t?ctober 1st of each near, !must file the following
forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's
C?ffice for all active lobbying issues_
1 } Lobbyist Expenditure Form
2) Disclosure Form
Failure to file these forms on a tirriely basis will result in my name being transmitted to the
Miami-Dade County Commission on Ethics and for code violation evaluation.
in addition, once are issue I haue registered to lobby on has beer resolved, ! am required
to immediately notify the City Clerk's C7ffice of lobbyist withdrawal in writing.
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Signature: Dote.