Michael J. Marrero - Marcel Serge Laik CA AIAMIB E.
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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 J.
NAME OF LOBBYIST: (Last) (First) (M.I)
Bercow, Radell&Fernandez, P.A. 200 S. Biscayne Blvd.,Suite 850 Miami Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)377-6238 (305)377-6222 mmarrero @brzoninglaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Marcel Serge Laik
NAME OF PRINCIPAL/CLIENT:
Novalis,LLC 20201 E.Country Club Drive, #2805 Aventura Florida 33180
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)]
• 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:
Lot Split at 5520/5530 La Gorce
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 Staff(Richard Lorber) None
Planning Board None
3o1 AJ0 s.�1. 10 'kilo
lei l
*Unless an issue is legislative in nature,HPB,BOA,Planning Board,and City Commission members are not lobbied outside of rbl -
C
ed�
LIAR 2 201� 'ul
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $3 7f / J_ r
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): 4 , 5- /1 r
(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 gi No: Are you lobbying 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 lobbying 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 a not - 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 a not - 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 COM NSATION DURING THE REPORTING
PERIOD.
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts ar e anrrect and that I have read or am familiar with the
provisions contained in Section 2-4 the ' i i y Code and all reporting requirements.
Signature of Lobbyist: l
1 /0 1 Signature of Principal /Client:
VI. LOBBYIST ID , CA ON: PRINCIPAL IDENTIFICATION:
❑ Produced ID ❑ Produced ID
_ _ _ _ _ _ Form of Identification Form of Identification
c,2 1
R , Personally known (Lobbyist) 50 P ersonally known ( Principal)
i
$
184 VII. SIGNATURE AND STAMP OF NOTARY: $ l
State of Florida, County of Miami -Dade State of Florida, County of Miami -Dade
1. Sworn to and subscrib before me Sworn and subscribed before me
This n da ti 3 c%i
day of (s. i ,veto This 1 day of 4 a29//
1
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Sig a ur - •,# - u • lic Notary — State of Florida Sivnature ,i ; ublic Notary — State of Florida I , r'l• ti
. Notarizati • of Lobbyist's signature Nbtarizat • of Principal's signature i_~
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY _ _ �" ,'
Annual Registration fee: [ ] Yes [ ] No Amount Paid � %4 I MICR # faarAr .' Date Paid 1Ii:%
Lobbyist Registration Form received and verified by : /
F : \CLER\sALL \AFORMS LOBBYIST FORMS‘Lobbyfist Registration Fore .doc l_ i ' 'r Revised 05/28/2010
•
„,0
‘IBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
Acknowledgement of fines /suspension from lobbying for failure to
comply with City of Miami Beach lobbying Laws
LOBBYIST NAME: / 6, `l
1 understand that no later than October 1st of each year, lobbyists subject to lobbyist
registration requirements shall submit to the city clerk a signed statement under oath
listing all lobbying expenditures, as well as compensation received, for the preceding
calendar year with regard to the specific issue on which the lobbyist has been engaged
to lobby. A statement shall be filed even if there have been no expenditures or
compensation during the reporting period. The statement shall list, in detail, each
expenditure by category, including food and beverage, entertainment, research,
communication, media advertising, publications, travel, lodging and special events.
FAILURE TO TIMELY FILE THE EXPENDITURE AND FEE DISCLOSURE REPORT
WILL RESULT IN A FINE OF $50.00 PER DAY. ANY LOBBYIST WHO FAILS
TO FILE THE REQUIRED EXPENDITURE REPORT BY DECEMBER 1, SHALL
AUTOMATICALLY BE SUSPENDED FROM LOBBYING UNTIL ALL FINES ARE
PAID, UNLESS THE FINE HAS BEEN APPEALED TO THE MIAMI -DADE COUNTY
COMMISSION ON ETHICS AND PUBLIC TRUST. In the event a lobbyist fails to
either file the report and /or pay the assessed fines, the Clerk shall notify the Miami -Dade
County Commission on Ethics and Public Trust.
IN ADDITION, ONCE AN ISSUE I HAVE REGISTERED TO LOBBY ON HAS
BEEN RESOLVED, I AM REQUIRED TO IMMEDIATELY NOTIFY THE CITY
CLERK'S OFFICE OF • BBYIST WITHDRAWAL IN WRITING.
/ o C f
Signature:
q �-
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1. CORPORATION
If the property which is the subject of the application is owned or leased by a CORPORATION, list ALL
the stockholders, and the percentage of stock owned by each. Where the stockholders consist of
another corporation(s), trustee(s), partnership(s) or other similar entity, further disclosure shall be
required which discloses the identity of the individual(s)(natural persons)having the ultimate ownership
interest in the entity.*
Novalis LLC
CORPORATION NAME
NAME AND ADDRESS % OF STOCK
Marcel Lalk
' 100
2021 Country Club Drive Apt.2805
Aventura, Florida 33180
N/A
CORPORATION NAME
NAME AND ADDRESS % OF STOCK
N/A
IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S)AND
EACHWDIVI,DUAL STOCKHOLDER'S NAME:ADDRESS, OFFICEAND PERCENTAGE OFSTOCK,
ON A SEPARATE PA GE.
NOTE Notarized signature required on page 8
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