Michael Marrero - Gerald Kosene AA Ve
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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
NAME OF LOBBYIST: (Last) (First) (M.I)
Bercow Radell & Fernandez, PA 200 South Biscayne Blvd., Suite 850 Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 374-5300 (305) 377-6222 mmarrerog)-bmwinalaw.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:
Gerald Kosene
NAME OF PRINCIPAUCLIENT:
1235 West Investments, LLC 20900 NE 30 Avenue, Suite 200 Aventura Florida 33180
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 377-6238
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2482(c)]
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: ,5I<� j�e 'Is. .
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUC-HICOiZP_ORATJON,
PARTNERSHIP OR TRUST: -
II.SPECIFIC LOBBY ISSUE:
Development Board Approvals for 1235 West Avenue, 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 priding 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
Planning Department and Building Department Staff None X
B, 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
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) $445
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). 5445
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 lobbxing on a present or gentling bid for goods.equipment or services,or on a present or
geri ing,award for goods,eau*gment 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 lobbving_peen aRp ication for a Developm�greement with the City or aggli�cation
fL change of zonina_p_ designation or change to the City's Future Land Use Ma?
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=regresenting a not-for-profit corporation or entity wit_necial 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 LO RYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED_ IN THE CITY OF MIAMI BEACH
FM THg RECEDING CALENDAR YEAR- A STATEMEN 1 RF FII E2_fjEN IF THERE HAV BEEN N.Q
EXPENDITURES OR COMPENSATION DURING THE 000f%0-r1k1f--OE
Signature of Lobb ist
I do solemnly swear that all of the foregoing fact a true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Miami h n ng requirements.
Signature of Lobbyist: v
Signature of Principal/Client•
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID ® Produced ID
Form of Identification Form of Identification
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Personally known(Lobbyist) E®o personally known(Principal)
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XVII. SIGNATURE AND STAMP OF NOTARY: `ca 00 3 .z CL Z
State of Florida,County of Miami-Dade Z°g w State of FI da ounty of Miami-Dade a n
Sworn to nd subscrib b forg me ��•vary Sworn ub ibed before me SL 1h cr C4 Cn
T o�� y of fJ,2014 a This S d y f ,2014 T °' v
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• Signature of 'ubli N to fate of Florida w ° g
S a ure of ublic No ary State of Florida g rX�.S C
Notarization of Lo_visignature Notarization of signature
TO BE COMPLETEQ0By CITY CLERK'S STAFF 014L D
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ (J MCR#_ 6 _ Date Paid __ _
Lobbyist Registration Form received and verified by:
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F:\Ct.E istration Form.doc Revised 04/27/2012
AAAMIBEAC H
City of Miami Beach, 1700 Convention Center (give, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Rafael E.GranRdo, City Clerk CityClerk@miamibeachll.gov
Tel:305.673.741 1 , Fax:305.673.7254
LOBBYIST NAME: Michael Marrero
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 Mi - de County Commission on Ethics and Public Trust.
Signature: v D#:
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CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
2. TRUSTEE
If the property which is the subject of the application is owned or leased by a TRUSTEE, list the
beneficiaries of the trust and the percentage of interest held by each. Where the
beneficiary/beneficiaries consist of corporations(s), another trust(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.*
N/A
TRUST NAME
NAME AND ADDRESS % OF STOCK
N/A
3. PARTNERSHIP/LIMITED PARTNERSHIP
If the property which is the subject of the application is owned or leased by a PARTNERSHIP or
LIMITED PARTNERSHIP, list the principals of the partnership, including general and limited partners.
Where the partner(s) consist of another partnership(s), corporation(s), trust(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.*
1235 wr..4 1hyr-5b% LLC
PARTNERSHIP or LIMITED PARTNERSHIP NAME
NAME AND ADDRESS % OF STOCK
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NOTE: Notarized signature required on page 8
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