Jeffrey Bercow - Edward Gadinsky /\AIAMI
BEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 331 994 JM9-g P�� 3. 3�
LOBBYIST REGISTRATION FORM s P Y L l j,
1~ {' defeat or
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage,
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.
Bercow Jeffrey
NAME OF LOBBYIST: (Last) (First) (M.I)
Bercow Radell & Fernandez, PA 200 South Biscayne Blvd., Suite 850 Miami Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 374-5300 (305) 377-6222 jbercow @brzoninglaw.cog4.,
TELEPHONE NUMBER: FAX NUMBER: EMAIL: ®'
Please notify this office if your contact information changes:address,phone, or e-mail address.-, `=°i
I. LOBBYIST RETAINED BY: e _
NAME OF PRINCIPAL/CLIENT: - �!
Mi-Lan Florida Investments, Inc. 325S. Biscayne Blvd, #1724 Miami FL 33131
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: ��f(� eclwwo
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: QG_A
II.SPECIFIC LOBBY ISSUE:
Development Approvals and Permitting Issues for Property located at 5324 Pinetree Drive,Miami Beach,FL
Issue to be lobbied(Describe in detail):
III. 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 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
Tanning Department and Building Department Staff None
B, HPB, BOA, City Commission, as necessary* None
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 Relationshi
/A
&O/F
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required)$575.00
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(Required). $575.00
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 NQ. Are you lobb`dna on a present or®ending bid for goods eauipment or services.or on a present or pending
award for aoods.equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
Yes X Nom Are you lobbying on a pendina Application for a Developmeol AarePment with the City or application for
rhanae of zonina map designation or chance to tlie—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 X Noe Are you representing a not for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
Qb1 FEBRUARY 98th QE EACH YEAR, EACH LOBBYISIS 10RAM To THE rdljY CL913K A510190 SIAIEMENT UNDER
EM
EXPENDITURES OR
h.
Signa r Lobbyi t
I do solemnly swear that all of t f regoi icts e tru nd c rrec and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami a City all repo g req rements.
Signature of Lobbyist:
J
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identification
Personally known(Lobbyist) Personally known
SIGNATURE AND STAMI�Q?Y''`'�� CRISTINAD.GON7�EZ
(Principal)VII. My COMMISSION#DD 960888
NOTARY: r •••••&�o TERESA MARIA !, .KS'�RES:March 23,204
MY COMMISSION#FF 042188 .' Bonded rhru Notary Public Underwriters
EXPIRES:December 2,2017
State of Florida, County of Miami- F�
OF 4r Bonde T%Budg otaryService! State of Florida,County of Miami-Dade
�
Sworn to an subscribed before me Swor n subscribed before me
This day of etQvt ,arji°� This day of DEGFa'16 91201
Signature of Public Notary—State of Florida Signature of Public Notary—SUe of Fldrida
Notarization of Lobbyist's signature Notarization of Princogal's signature
TO BE COMPLETED BY CITY CLERKS STAFF ONLY
Annual Registration fee: [ ]Yes[ No Amount Paid I V"'- MCR# g/�n� Date Paid
Lobbyist Registration Form received and verified by: ,MAt f 0 4
® /\AIAMI BEACH
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
LOBBYIST NAME: Jeffrey Bercow
I understand that no later than February 28th of each yeas', 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, 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 $50.00 a day shall be assessed for all Statement(s)
filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on
Ethics and Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the
assessed fines after notification.
Any lobb ist, who fails to fil the required Statement by April 30th, 2012, shall be
autom is lly suspended f lobbying until all fines are paid, unless the fine has been
app ale to the Miami-D de ounty Commissio n Ethics and Public Trust.
Si na Date:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
i_=< �i `?. i 4jty rte.
Miscellaneous Cash Receipt _ `' ��_ `a
CITY OF.MIAMI BEACH
w
No. :
-
p ❑ Cash
13 Credit Card heck# �
4 n
�.. 20
Received of f If'
�-•• Address
Foy ' to
i ) �Y4-: .�� � @p[�$) �F �Yi � '' �� e ���_ .sn y� � �f 1 d��- `�( ����°/ fi.�,f j/f./`�•'��(�ti 1 ;J
.� E f "=.�!� � i'H f'°� ���'� �? 98�__ �L:_ ." _ �.Jn � ii l.d l�- ._-� �, 'I 3/P�.�.- f�4.•'G„ 117;.4
F ..
M '
(THIS INFORMATION MAST BE COMPLETED) Office'of.Finance Director
By
Account Number: fV
r �'`4. r..
Preparer• ! Dept: t �. � EXT:
;�