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Monika Entin - Gianfranco Rondon MIA/\A1 BEACH R1q , 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. Entin Monika NAME OF LOBBYIST: (Last) (First) (M.1) Bercow Radell&Fernandez, P.A. 200 South Biscayne Boulevard, # 850, Miami FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-377-6237 305-377-6222 MEntinAB ninaLaw.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: Gianfranco Rondon NAME OF PRINCIPAUCLIENT: RG Michigan 2014 11251 NW 20th Street, Suite 106, Miami FL 33172 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (786) 497-4521 c/o g.rondon@qrouo-M.com 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: Gianfranco Rondon 99% r, • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH,C-B-,RPORATION, PARTNERSHIP OR TRUST: ii.SPECIFIC LOBBY ISSUE: Development Approvals and Permitting Issues, including, but not limited to Historic Preservation Board,Planrt Board, Board of Adjustment, Land Use Development Committee, and City Commission, if necessary, relating to the prgper located at 419 Michigan Avenue, Miami Beach,FL. Issue to be lobbied(Describe in detail): Ili. CITY AG ENCI ESA NDIVI DUALS 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,Public Works and Fire Department Staff None. B, DRB,HPB, BOA, City Commission, and Land Use None. Development Committee, as necessary Pursuant to City Code Section 2-482(8)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 None- C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registratio Formrevised 5-30-2012.doc ��1.� 09 �/7/Z,,,Jul IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)$375.00/hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $375.00/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 lobbying on a present or pending bid for goods,eauioment or services,or on a present or pending award for goods,eauioment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes)CNo: Are you lobbvina on a pending application for a Development Agreement with the City or application for chanae of zoning map desianation 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)No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement. V. SIGNATURE UNDER OATH: ON FEBRUARY 28 OF EACH YEA8. EACH LQBBYIST SHALL SUBMI E—C CLERK A SIGNED STATEMENT UNDER QATH. LISTING LQBBXlblra EXEEbIDIJUBES, AS JUELL Ag SATION REC . IN THE CITY OF MIAMI BEACH EM THE PRECEDING QALEbjDAR YEAR, A STATE 1zS' NALL 13E FILED EN IF THERE HAVE BEEbj NO EXPENDITURES OR Signature of Lobbyist I do solemnly swear that all of the foregoing facts are true a correct an at I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all re orting requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ;,.s ;••.,,, o, Produced ID = "ti••. ' , Produced ID Form of Identification Form of Identification =`aP t e 1�C,. 2 &Personally known(Lobbyist) �''�••�•••�'��, Personally known(Principal) o oz 3. as VII. SIGNATURE AND STAMP OF NOTARY: o n at H Q •" State of Florida, County of Miami-Dade W n 'M State of Florida, County of Miami-Dade T m Sworn toxd subscribed before me 34. " Sworn a d subscribed before me o T This da of ,2014 T a This day of , 2014 T a at. T X A T N d — Ca r G • T ® O• Sign ur of c tary—State of Florida o o ign a Ii c otary—State of Florida Notarization signature g � otariza ' Primal's signature TO BE COMPLETED B CITY CLERK'S Sj#FF ON Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# - Date Pajj Lobbyist Registration Form received and verified by: MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, w%v-.v.miamibeachfl.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerk@ miami beach tl.gov Tel:305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: Monika 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 Mia I ounty Commission on Ethics and Public Trust. Signature: Date: C:\Users\clerhatlWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc � f Ml 66,1laneous`Cash,R'ceipt CITY`OF MIAMI BCH r. I , .;.Cash c Credit Card: ;Check-# Ap Received of.. ° per. dress Fir 2/4 1' INpt'?RMAYION i1�t1ST BE COMiPLETEt3j - Office :of Finance'Director rp' 61• . Account Number: ! c pr®parer: .�' Dept:. EXT: f JS 1� I J L.`Li•`-1<�1-' 'o I' .ill ,L5.,1 t r�%,l,i.l S�..i„ rljfl 4,• .Ydws' ir:,' a f' , "t��,:. A .�' A4 ,,'i 31y.1.-;-:✓ �C�S ln.,� rW� .1'" �I. ��= t �•' 1- .,u7 EA Z