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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.
Entin Monika
NAME OF LOBBYIST: (Last) (First) (M.I)
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 MEntin(BRZoninaLaw.corn
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Dannu Lavy, MGR
NAME OF PRINCIPAL/CLIENT:
818 Lincoln Investments, LLC- 3510 St. Joseph Boul East Montreal. Quebec H1X 1W6, CANADA
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
15141223-5459 c/o Kim Cienki kcien.ki(a,sh.illertirou/p.Corn
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) r-'
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)]
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: Danny Lavy, MGR - -
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: See Exhibit A,attached.
II.SPECIFIC LOBBY ISSUE:
Development Approvals and Permitting Issues, including, but not limited to the Historic Preservation Board, 1r'gnning Board,
Board of Adjustment, Land Use Development Committee, and City Commission, if necessary, relating to the property located at
818 Lincoln Road, 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
Planning, Building, Public Works and Fire None X
nonnrtmpnt staff
PB, HPB, BOA, City Commission, and Land Use None X
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
Nnnp
Nnnp
Nnnp
6,°r
"QS.
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 XNo: Are you lobbying on a present or pendina bid for goods.eauipment or services.or on a present or pending
award for goods.eauipment or service?,
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes XNo: Are you lobbvina on a nendina application for a Development Aareement with the City or application for
chanae of zonina map desianation or chanae 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.
_YesXNo: Are you representina a not-for-profit corporation or entity without special compensation or reimbursement,
V. SIGNATURE UNDER OATH:
Q■ FEBRUARY 28 OF EACH YEAR.EACH LOBBYIST SHALL SUBMIT TO TH TY CLERK A SIGNED STATEMENT UNDER
OATH. LISTING LOBBYING EXPENDITURES. AS WELL AS CQMPE N RE ED. IN THE CITY OF MIAMI BEACH
EQB THE PRECEDING CALENDAR YEAR. A STATEMEN ALL BE FILED EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR •I/• . _ •. I : k -• ►_ - •l
JI A�
Signal=r.111 :byis
I do solemnly swear that all of the foregoing facts are true and cor - t and that I have ead or am familiar with the provisions contained
in Section 2-482 of the Miami Beach City Code and all repo'in• equirements.
Signature of Lobbyist: ' 4n1
Signature of Principal/Client: //% /��∎∎∎'
VI. LOBBYIST IDENTI •N: PRINCIPAL IDENTIFICATION:
Produced ID �' L Produced ID
Form of Identification �/ �� �F Form of Identification
1
Personally known(Lobbyist) Personally known(Principal)
n
VII. SIGNATURE AND STAMP OF NOTARY: 3 1.4
N v Q! 1f Q
State of Florida,County of Miami-Dade «m g
Sworn • and subscribed Wore me Sworn and subscri ed •_ •re •e
This '�_ d.i • WOb�12014 Z I 1 a This 4/ day of 0 - • - , 2014
Ur& /
.l-_A r 1 a-a. — _, Al ing.a 1.1 1 e
Sign,ture -4 :t `" ary-S to of Florida i o' Signature o''ublic Notary- - • - .•
Notarizatio -.. •b•vist's signature a;ff Notarization of Efigcioal's signature
TO BE COMPLE ED Y CITY CLERK'S ST,FF ONLY / / S
Annual Registration fee: [ Yes[ ]No Amount Paid MCR y ,� Date Paid
Lobbyist Registration Form received and verified by - , . � . b
a
& �
. a wa .wry
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: 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 Mi. .e County Commission on Ethics and Public Trust.
1/7
Signature: Date:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
EXHIBIT A
DISCLOSURES
818 Lincoln'Investments, LLC
3510 St. Joseph Boul East, Montreal Quebec, H1X 1W6, CANADA
CORPORATION NAME AND ADDRESS
NAME AND ADDRESS %OF STOCK
Lincoln 818 Real Estate 50%
C/O 20295 NE 29th Place, Ste. 200
Aventura, Florida 33180
Mariposa Real Estate, LLC 50%
2711 Centerville Road, Ste. 400
Wilmington, Delaware 19808
Lincoln 818 Real Estate
C/O 20295 NE 29th Place, Ste. 200, Aventura, Florida 33180
CORPORATION NAME AND ADDRESS
NAME AND ADDRESS % OF STOCK
Shilldev (US), Inc. 50%
111 S. 17th Avenue
Hollywood, Florida 33020
Danlav Lincoln Properties Corp. 50%
C/O 20295 NE 29th Place, Ste. 200
Aventura, Florida 33180
Shilldev(US)Inc.
111 S. 17th Avenue, Hollywood, Florida 33020
CORPORATION NAME AND ADDRESS
NAME AND ADDRESS %OF STOCK
Stephen Shiller 100%
111 S. 17th Avenue
Hollywood, Florida 33020
Danlav Lincoln properties, Inc.
C/O 20295 NE 29th Place, Ste. 200, Aventura, Florida 33180
CORPORATION NAME AND ADDRESS
NAME AND ADDRESS %OF STOCK
Danny Lavy 100%
C/O 20295 NE 29th Place, Ste. 200
Aventura, Florida 33180
Page 1 of 2
Mariposa Real Estate, LLC
2711 Centerville Road, Ste. 400, Wilmington, Delaware
CORPORATION NAME AND ADDRESS
NAME AND ADDRESS %OF STOCK
Martin E. Franklin 100%
5200 Blue Lagoon Drive, Suite 855
Miami, FL 33126
Page 2 of 2
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