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Mathew Amster / MCM Corp - Lloyd Mandell 0-01 G-v MIAMI BEA - City of Miami Beach Office of the City Clerk l 1700 Convention Center Drive, Miami Beach, FL 3313Al2 JUN 18 pvy �- LOBBYIST REGISTRATION FORM `' 12 Lobbyist means all persons employed or retained, whether aid or not, b a principal who seeks to en'cou a b Ffh0 s e- feat or Y P P Y P P g P �9 .y t modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation f he 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. Amster Matthew NAME OF LOBBYIST: (Last) (First) (M.1) Bercow Radell & Fernandez, PA 200 S. Biscayne Blvd, Suite 850, Miami, FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (_305) 377-6236 (305) 377-6222 mamster(o-)brzoning law.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes: address,phone, or e-mail address. I. LOBBYIST RETAINED BY: M.C.M. Corp —Lloyd Mandell President NAME OF PRINCIPAL/CLIENT: Same 1741 Collins Avenue Miami Beach FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 503-1440 (305) 503-1446 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: Lloyd Mandell, President • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Lloyd Mandell-50%;Arundell Properties-27.5%; Enrique Chediak Jr.-7.5%;Francisco Jose Chediak-7.5%; and Felipe Chediak-7.5% n.S'PECIFIC LOBBY ISSUE: Development approvals and permitting issues for property located at 1741 Collins Avenue, Miami Beach, FL Issue to be lobbied(Describe in detail): nl. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(x)(4) include the commissioner or personnel sought to be lobbied, and wh3th2r the lobbyist has entered into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such person's commencement of service with the city to the present date,stating the general nature of the subject contractual relationship. Sec 2-482(a)(4) Full Name of Individual and Contractual Relationship(Explain) YES NO title of person to be lobbied Staff of Planning Department, Building Department, and Public Works None X Department PB, HPB, BOA,City Commission, as necessary* None X Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,familial or professional relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner or city personnel who is sought to be lobbied as identified on the lobbyist registration form filed. Sec 2-482(g)Any Financial, Familial or Professional Relationship None *Unless an issue is legislative in nature,PB,HPB,BOA,&City Commission members are not lobbied outside of a public hearing setting. C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration , Formrevised 5-30-2012.doc Z4 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE: (Required) $325/hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). $325/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 lobby'na on a uresent or pending bid for goods, eauinment or services, or on a present or Dendina award for goods, eauinment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes X No: Are you lobbvina on a Dendina application for a Development Aareement with the City or application for chanae of zonina map desianation or chance to the City's Future Land Use Map? 3) Pursuant to Miami Beach City Code Section 2-482 (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 X No: Are you rnnresentina a not-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON FEBRUARY 28 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 REPORjjW&EfBLQD,,�7 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 an all reportin equirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: LU L _Produced ID _Produced ID Woe, Form of Identification Form of Identification '_ a' Q N a � Personally known (Lobbyist) Personally known (Principal) VII. SIGNATURE AND STAMP OF g IS 0"Ay 1P 1, CRISTINA D.GON;U_.nd__eRw)it_ers " _ State of Florida, County of Miami-Dade =* �= MY COMMISSION#DState of Florida, County of Miami-Dade Sworn to grid subscribed before me ? .., d'= EXPIRES:March 2Sworn and subscribed before me pF Bonded Thru Notary PubliThis l day of .twrQ� 2012 This day of 1)clN4– , 2012 J'/ yynnN•' Signature of Public Notary–StUte of F ida Signature of Pu41 ota —State of Flo a Notarization of Lobbyist's signature Notarizatio f, rin i pat's signatur TO BE COMPLETED BY CITY CLERK'S STAFF ON Annual Registration fee: [ ]Yes[ No Amount Paid$ r MCR# Date Paid / Lobbyist Registration Form receive an ven ie y: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc F:\CLE r istration Form.doc Revised 04/27/2012 I , I f LiINAA I Ek E A C City of Miami Beach, 1700 Convention Center Drivc, Miami Beach; Florida 33139. +v+vw.miamibcachfl.gov CITY CLERK 011ice Rafael F. Granado, City Clerk CiiyClerknmiamibeaclin.gov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: Matthew Amster I understand that no later than February 28 of each year, I must file the following form, 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 AND COMPENSATION 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 I have registered to lobby on has been resolved, or I am no longer lobbying on that issue or for that principal, I am required to immediately notify the City Clerk's Office of lobbyist withdrawal in writing. Pursuant to Section 2-485 (d), the City Clerk shall notify any lobbyist (or principal) who fails to timely file a Statement and in addition to any other penalties which may be imposed as provided in Section 2-485.1, a fine of $50.00 a day shall be assessed for all Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on Ethics and Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the assessed fines after notification. Any lobbyist, who fails to file the required Statement by April 30th, 2012, shall be automatically 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. Signature: Date: C:\Users\clerhatlWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc