Juan Fernandez-Barquin - Sherbrooke Apts MIAMI BEACH A � q`� ,
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City of Miami Beach Office of the City Clerk �C l N S
1700 Convention Center Drive, Miami Beach, FL 33139 Cho
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.
Fernandez-Barquin, Juan
NAME OF LOBBYIST: (Last) (First) (M.I)
2520 NW 97th Avenue, Suite 240 Doral Florida 33172
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786) 336-0881 jfbeng @bellsouth.net
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Sherbrooke Apts. Inc., a Florida Chapter 719 Cooperative Non-Profit Corporation
NAME OF PRINCIPAUCLIENT:
901 Collins Avenue, Miami Beach, Florida 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 532-0958
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:
Mitch Novick, President
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY ISSUE:
Representation concerning Sherbrooke Apts. Inc. related to development at 919, 909 and 901 Collins Ave.
Issue to be lobbied(Describe in detail):
lll.CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2-482(a)(4)include the commissioner or personnel sought to be lobbied,and whether 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 eneral 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
Zoning B oar o Adjustment None
Planrnn Board None X
Lan Use Board None X
City Commission None X
Planning Board one X
ursuan 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 cgmmissipner,or Fity personnel who is
sought to be lobbied as identified on the lobbyist registration form filed. 7`j I a�- L: , !4,?i_1 1.1 f J
Sec 2482(g)Any Financial, Familial or Professional Relationship
City Agencies/individuals to be Lobbied continued: I Nnr EIOl
City Attorney's Office None
Mayor None ( � 6 i E X
There is no financial, familial or professional relationship
f
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required)
$?QQ M/hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(Required). $2171 n-nn/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 (9 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.
L Yes )Oo: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement. .
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th OF EACH YEAR EACH LOBBYIST SHALL SUBMIT T THE CITY CLERK A SIGNED STATEMENT UNDER
OATH LISTING LOBBYING EXPENDITURES AS WELL AS COMPENSATI N RECEIVED IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED E EN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature of Lob yi
do solemnly swear that all of the foregoi facts 2true and corre nd tha have read or am familiar with the provisions contained
in Section 2-482 of the Miami B o reporting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATIO PRINCIPAL IDENTIFICATION:
Produced ID FLOC f— El Produced ID
Form of Identification Form of Identification
❑ Personally known(Lobbyist) Personally known(Principal)
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VII. SIGNATURE AND STAMP OF NOjQ,••"•'••. ���' �QHAN)F9�%'
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State of Florida, County of Miami-Dade = �� :y _ State of Florida, County of Miami �o n
j'�ipAW4 orn tq and subscrib befor me = ®®® = Sworn apd subscr' ed before m¢ z • ®® �,N
s day of 2013 y Z - ,#EE191q This day o 3 'pFF> > z
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of Public Notary—State of Florida 4�i�Bl/�STATE'3F �``�` Agnat a of Public Notary—State of Florida 'C Srq OF F\OP\p�`��
Notarization of Lobbyist's signature 4/fillIIjj1 , Notarization of Principal's signature '001111111IIIM\0
TO BE COMPLET Y CITY CLERK'S STAFF ONLY (. 11 1 1//f, :g
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ Z5 O MCR# Date aid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 1/11/2011
IM MIAMBEACH
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City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.741 1 , Fax:305.673.7254
LOBBYIST NAME: c1
I understand that no later than February 28th 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 i sue I have registered to lobby on has been resolved, I am required
to immediately notify t e City Clerk's Office of lobbyist withdrawal in writing.
Signature: V D(ate: