Monika Entin - Seville Acquisition, LLC MIAMI BEACH ,
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.
NAME OF LOBBYIST: (Last) (First) (M.I)
Bercow Radell&Fernandez, P.A., 200 S.Biscayne Blvd., # 850,Miami, FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
10400 Fernwood Road Bethesda MD 20817
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
1301)38Q-.a182. c lo o t
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: See Attached c) a
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5°/OR MORE OWNERSHIP INTEREST IN SUCFf"COReaRATION,
PARTNERSHIP OR TRUST: See Attached
II.SPECIFIC LOBBY ISSUE: o
Development Approvals and Permitting Issues, including, but not limited to Historic Preservation Board, Planhing.gd Board of
Issue to be lobbied(Describe in detail): .0
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: �z7 cn
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
arson's commencement of service with the city to the present date a tInS the general nature of the subject contractual relationship.
Sec 2-482(x)(4)Full Name of Individual and Contractual Relationship(Explain) YES I NO
title of person to be lobbied
Planning Department and Building Department Staff None ly
B, DRB, HPB, BOA, City Commission, and Land Use None
Development Committee, as necessary None
Pursuant to City Code Section 2482(g)Every registrant shall be required to state the extent of any business,financial,familial or professional i
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 Any Financial Familial or Professional Relationship
lVanp-
/ 14
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required): $330.00 per hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):$330.00 per hour
(REQUIRED).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Issues":
_Yes X No: Are you lobbyina on a present or oendina bid for aoods.eauloMent or services,or on a_oresen_t or
pending award for goods.eauipment,or service?
2) Pursuant to Miami Beach City Code Section 2-480 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes X No:
j2E change of zoning map d ,;,i_anatio„n or�hatrae to the Citv's Future Land Use Man?
3) Pursuant to Miami Beach City Code Section 2-482(h)Any person(except those exempt from the definition of"lobbyist”as set
forth in Section 2-481 above) who only appears as a representative of a not-for-profit corporation or entity without
special compensation or reimbursement for the appearance, whether direct, or Indirect, to express support of or
opposition to any item,shall register with the clerk as required by this section but,shall not be required to pay any registration
fees.
Yes X o•
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH_y
OATH. LISTING L0l313XING.=NDlT1JjjES- AS WE _EN D. IN THE QU QE MIAIJIJWAO
EXPENDITURES OR
2MENSA-11171ION DURING THE 0 In
Signature of Low
I do solemnly swear that all of the foregoing facts a true and correct and' t I have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach City Code a all rep g Fequirements.
Signature of Lobbyist:
(Signature of Principal/Clie t:
VI. L08$YIST IDENTIFICATION; PRINCIPAL IDENTIFICATION:
_Produced ID „4,.Produced ID
Form of Identi atJORN& Nom,Public State of Florida Form of Identification
Diana Ramos
ZPersonally known(Lobbyist) MY Commission EE08228a Personally known(Principal)
or a ExPwm 04/10/2015
VII. SIGNATURE AND STAMP OF NO A Donna i s n ZAAa
NOTARY PUBLIC /I'7/�Ry /'Y10NTG,0/yl ,y
State of Florida,County of Miami-Dade State of Flees County of
Montgomery County
Sworn t d s bscrib� f me Sworn a ubscdbed before me
Thi d of �,2013 MARYLAND T Is l; ay of NOVf.,/I9�9�rQ2013
1(� My Commission Expires Dec. 10-,-40 0
a1 v N
Signat a of Public Notary—State of Florida Signature of Public Notary—State of Biel /1AyZ0 1 ,
Notarization of Lobby's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S ST F N /
Anniml ReqfStrnfinn fee- Yes f I bin Amount Paid S_ ;3 mr-P it Oat.Pa
�Q--
Lobbyist Registration Form received and verified by: ,
f�
DISCLOSURE OF INTEREST
1. CORPORATION
If the property which is the subject of the application is owned or leased by a CORPORATION, list ALL of 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.*
Seville Acquisition, LLC
10400 Ferntuood Road,Bethesda, Maryland 20817
Courtyard Marriott Corporatiolz 100°0
10400 Fernwood Road
Bethesda. AID 20817
Courtyard Marriott Corporation
10400 Fe?71WOod Road, Bethesda, Mantland 20817
Mal77ott International, Inc. 100°0
10400 Ferizwood Road
Bethesda, AID 20817
Marriott International, Inc.
10400 Fernwood Road, Bethesda Maniland 20817
Marriott International. Inc. 100%
Maniott International, Inc. is a publicly traded
company under the symbol AMR on the New York
Stock Ea:chancte,
IF THERE ARE ADDITIONAL CORPORATIONS, LIST OTHERS, INCLUDING CORP. NAME(S)AND EACH INDIVIDUAL
STOCKHOLDER'S NAME,ADDRESS, OFFICE AND PERCENTAGE OF STOCK, ON A SEPARATE PAGE.
NOTE: Notarized signature required on page 8
6
F:\CLE istration Form.doc Revised 04/27/2012
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.7411 ,Fax:305.673.7254
LOBBYIST NAME: _Mon ka Entin
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- iami-Dade County Commission on Ethics and Public Trust.
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