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Michael Marrero - Scott Greenwald 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. Marrero Michael NAME OF LOBBYIST: (Last) (First) (M.I) Bercow. Radell & Fernandez, P.A. 200 S. Biscavne Blvd. Suite 850 BUSINESS NAME AND ADDRESS (Number and Street) (City) Mlaml (State) ~,L (Zip Code) 3 31 31 305-377-6238 305-377-h222 mmarrPrc~fdhr~c~ni nil aw_ Com TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: Scott Greenwald NAME OF PRINCIPAL/CLIENT: GFS Cor 7301 SW 57 Court BUSINESS NAME AND ADDRESS (Number and Street) City) (State) (Zip Code) TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] o 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: n.SPECI~IC L®~~Y ISSUE: Lobhyi ~t-_ RPCrI ~trat-i nn 7f11 (1_7(11 1 _ ~ S°~o ~ ~/1 `~ /~r~1'PC '~ Issue to be lobbied (Describe in detail): ~- _. III. C~T°Y Q-~EI~C~ES~II\I®~~f®lJ~lLS ~~ ~'~ L~~~'~~: Pursuant to City Code Section 2-482(g) include a statement of the extent of any business, financial, familial, professional or other relationship, giving rise to an appearance of an impropriety with any City personnel sought to be lobbied -- further, pursuant to City Code Section 2- 482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding said City personnels' commencement of service with the City to the present date, stating the general nature of the subject contractual relation. A Full Name of Individual Title B) Any Financial, Familial or Professional Relationship Historic Preservation Board Board of Adjustment Plannin Staff /sv IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) ~ 2 / ~ / lA®~~ B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). 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 ~lo• Are you lobbvinq on a present or pending bid for goods, equipment or services, or on a ~~ present or pending 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": ^ Yes ~NO: Are you lobbvinq on a pending application for a Development Agreement with the City or application for change of zoning map designation or change to the City's Future Land Use Map? 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 ~ No: Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1sT 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_COMPENSAT~N DURING THE REPORTING PERIOD. Signature of Lobbyist ~ ~ ~' ~ ~, . 01 N ~a ~ ~ ~' ~. goT-y ~PP~~ O~~~L7 ~~Qh~a ~ ~ ~ I do solemnly swear that all of the foregoing provisions contained in Section 2-482 of t~ P Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: ^ Produced ID Form of Identification ersonally known (Lobbyist) VII. SIGNAT E AND STAMP OF NOTARY: State of Florida, o nt Miami-Dade Sworn ri fore men This v o _2 _ PRINCIPAL IDENTIFICATION: Produced ID ~ ~ L-~~ Form of Identification H p -vi ~ .--. iii ~ ~ ca, `,~~~~V,,~ ~8q E: . 9G '~~ ,~i~pu+••A voq Signat e ~T~blic Notary -State of Florida N ~zation of Lobbyist's signature ~•.,ev.s... TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ~~ ]:Yes [: ] No Amount Paid $ ~S~ MCR # -: Date Paid Lobbyist Registration Form received'and verified'by: ~. ~~~:~~~~trt.t.~ A~;~~~a' ~r~~3~°~_~;~~~k,i~~ ~~~,~~~ex~~~~~~>~ ~'~-~,< ~~.~:~~.~~~~~: Revised-02/1'1/2009 true and correct and that I have read or am familiar with the ch City Code and all reporting requirements. ^ Personally known (Principal) \~i~~~titlolirir~/`/~o~i >>~ M R. H <r ~ \P State of Florida, County of Miami-Dad~~\ : ~~~M~arYSj~~ •°%lOf Sworn and subscrib d efore me ~'* ~° ~~~~~ g2~~'o This day of ~ , 208_ ®. 4' ~ e I. ./ • ~ 1. Z ~; #~0 832367 .° = ignature of Public Notary- St a of is~• ~~dm"' ~`~~OQ~~`' Notarization of Principal's signature '~i/~B/jU• ST °TE ~Fk\'d,`+'"'a 0//INioee~elll~~'~ . ; <: City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Tel: 305.673.741 1 ,Fax: 305.673.7254 CityClerk@miamibeachfl.gov LOBBYIST NAME: M ~ f . Y I fie I r " ` ~ 'r ~ I understand that no later than Ott®ber 1st ®f each ~, 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-Dade County Commission on Ethics and for code violation evaluation. In addition, once an is I have registered to lobby on has been resolved, I am required to immediately noti e Clerk's Office of lobbyist withdrawal in writing. Signature: ':~~t~,~Yi"~";la,i~ ~-~i~~°~~i-~ ~~ `~="~x~~~~ ;~2 ~0,~1~.~ ~' ~ I o .\~,~