Jeffrey Bercow - Twenty-Two Star Island LLC VkIAMI B � G
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.
Bercow Jeffreu
NAME OF LOBBYIST: (Last) (First) (M.1)
Bercow Radell&Fernandez, P.A. 20Q South Biscayne Boulevard, # 850, Miami FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-377-6220 305-377-6222 JBercow(R13RZoninaLaw.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:
Stuart A. Miller
NAME OF PRINCIPAUCLIENT: f
Twenty-Two Star Island LLC 700 NW 10714 Avenue Miami FL 33172
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-229-6554
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.
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY ISSUE:
Development Approvals and Permitting Issues, including, but not limited to Design Review Board, Board of Adjustment,
Planning Board, Land Use Development Committee, and City Commission, if necessary, relating to the property located at 22
Star Island Drive, Miami Beach,Florida.
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
Planning, Building and Public Works staff None.
PB, DRB, BOA, City Commission, and Land Use None.
Development Committee, as necessary
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
1,4� ►
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Formrevised 5-30-2012.doc 7 i P_�*'3
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)$600.00/hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $600.00/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)No: Are you lobbyjna on a present or pending bid for goods,eauipment or services. or on a present or pendina
award for oog_ ds,equipment or service?
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes JCNo: Are you lobbying on a pending application for a Develooment 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 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)CNo: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR. EACH LOBBYIST SHA SUBMIT TO THE CITY CLERK
RECEIVED,QATH. LISTING LOBBYING EXPENDITURES, AS WELL AS,.,dQMPENS TION C C
FHB THE PRECEDING
EXPENDITURES OR COMPENSATION DU PERIQD-.//��
Sign r o obb is
I do solemnly swear that all of the foregoing facts are true an correct d that I e read or a amiliar with the provisions contained
in Section 2-482 of the Miami Beach City Code and all reporting requir ments.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Id 1)(407)..3'98--0153 RISTINA DIANA GONZALFZ Form of Identification
MY COMMISSION#FF083128
?' :"O. EXPIRES ES March 23,2oi8 Personally known(Principal)
Personally known(Lobbyis Floridallotaryservice.com
VII. SIGNATURE AND STAMP OF NOTAR
r► R.MUELLER
t ...y
State of Florida, County of Miami-Dade ! MY COMMISSION 5.201 706 tate of Florida, County of Miami-Dade
EXPIRES:SEP 25,2017 orn an ubscrib d before me
Sworn to a d subscribed before a °P Bonded through 1st St uranc
This 2-°► — day of I, 2014 s ay of 2014
Signature of Public Notary tate f Flori Sig ature of Public Notary—State of Florida
Notarization of LobbYlst's signature NN arization of Principal's signature r�
TO BE COMPLETW DX CITY CLERK'S T F O Y .G
tobbyist nnual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# e Paid
Registration Form received and verified by:
MIAM-1 BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamlbeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Far:305.673.7254
LOBBYIST NAME: Jeffrey Bercow
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 I ist, who fails file the required Statement by April 30th, 2012, shall be
auto, ati ally suspend d om lobbying un fl-all fines are paid, unless the fine has been
appeale to the Miami-D de County Co fission on Ethics and ublic Trust.
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Sign u Dat .
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Formrevised 5-30-2012.doc
DISCLOSURE OF INTEREST
Twenty Two Star Island, LLC
700 NW 107th Avenue
Miami, FL 33172
100%
SM Alpha LLP
700 NW 107th Avenue
Miami, FL 33172
98 %
Stuart A. Miller 2010 Family Irrevocable Trust
700 NW 107th Avenue
Miami, FL 33172
1%
S. M. Stuart Miller Irrevocable Trust
700 NW 107th Avenue
Miami, FL 33172
1%
SM Alpha, LLC (owned 100% by Stuart A. Miller)
700 NW 107th Avenue
Miami, FL 33172
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