Michael A. Gil/Alan Waserstein~ ~ ~ ~~
X03
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 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:
Alan Waserstein
NAME OF PRINCIPAL/CLIENT:
Charms 63 Nobe, LLC 6001 NW 153 Street, Suite 110 Miami Lakes Florida 33014
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 827-8373 wasrco@aol.com
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: Alan Waserstein
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: Alan Waserstein, Richard Waserstein, Charles Waserstein, and Marta
Waserstein
II. SPECIFIC LOBBY ISSUE:
Board of Adjustment Application for 103 63rd Street
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., BOA, Planning Board, City Commission * None
J E J '~ i7 ,.. , '-'
~£ :~ ~a ~~ ~nr ~
* Unless an issue is legislative in nature, HPB, BOA, Planning Board, and City Commission merr`t~ers are not lobbied outside of a public hearing setting.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER /!Oi'/RL);
FL4T RATE OR OTHERJ:
A) LOBBYIST DISCLOSURE: (Required) S 220.00 oer hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). S 220.00 ner 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 Dresent or oendina bid for gds, eauinment or services, or on a
present or pending award foryoods,,gggiwnept or service
2) Pursuant to Miami Beach City Code 2-490 Entitled °Prohibited Campaign Contributions By Lobbyists On Real
Estate Devebpment Issues":
oyes X No• Are you lobbvina on a cendina auolication for a Develoumerrt^~greement with t~ City or
application for chance of inning map designation or chartwge ~ the Citv's Future Land Use
Mao?
3) Pursuant to Miami Beach City Code 284 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Sedion 2~$1 above) who only appears as a representative of anot-for-profit
corporation or entity without spatial compensation or reimbursement for the appearanol', whether direct, or
indirect, to express support of or opposfion to any item, shall register with the dark as required by this
sedion but, shall not be required to pay any registration fees..
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 NAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD.
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts ar
familiar with the provisions contained in Section 2-482
requirements. _ ~
Signature of Lobbyist:
and correct nd that I have read or am
Miami Beach City Code and all reporting
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
^ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Swom to and subscribed before me
This day of . 20_
Signature of Public Notary -State of Fkxida
Notarization of Lobbyist's signature
Form of Identification
^ Personally known rah ~1) TERESA L MARQUES
~ ; - MY CAMMISSION # DD 653705
:..
._' EXPIRES: April 3, 2011
~~ ~~ ~~ Bonded Thru Notary Public Underwdts»s
State of Florida, County of Miami-Dade
Swo d ~bscritz~i, before me
Thisday of ,~~~, 20
rgnature of lc otary -State of Florida
Notarization of Principal's signature
FOR CLERK'S USE ONLY 3 D
Annual Registration fee: [ ]Yes [ ] No Amount Paid ~ ~- MCR # ate Paid
Lobbyist Registration Form received and verified by: Entered By:
F:\QER\#ALL\MARIA-M\lobbyist\LOBBYISr 6ORM OS.doc Revised 12J08/04
Form of Identification
^ Produced ID
~~ _
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City of Miami Beath, l; r~ Canvenfion Center give, lWiomi ~eoch, Faorida 33139, www.miom'ipeochN.aov
CITY CIERK Clffice Cih~Clerk~rniamitaeachfi.gov
"feE: 3135.673.74 ~ ~ ,Fax: 3G'5.673.725d
~.C?BBYlST NAME: ~~
! understand that no .later than Qcbber 1st of eoch--~reor, I must file the following
forms, pursuanfi to Secfiian 2-4$5 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 timely basis will result in my name being transmitfied to the
Miami-pade County Commission on Ethics and for code violation evaluation.
In addition, once an issue 1 heave registered to lobby on has .been resolved, [ am required
to immediately notify the City Clerk's Office of lobbyist wifihdrawal in writing.
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signature: Cate: