Marc A. Halpern - 1500 Ocean Drive I S4 Co
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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.
NAME OF LOBBYIST: (Last) (First) (M.I) 649
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) / 33/34-
T EPHONE NUMBER: FAX NUMBER: •'MAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAUCLIENT: �f� i r l
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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: AA
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDI ECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
ii.SPECIFIC LOBBY ISSUE: v l�
f` ,� a ` 7,--' /5 93 CO 1,✓-'
Issue to be lobbied(Describe i 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 cj.eneral 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
PZ.4 ills/IA) 6—
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
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
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B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST PENSAT ON :
(REQUIRED). di., Z t
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Is es":
_Yes o: Are ou lobb in• on a •resent or •endin• bid for •oods e•ui•ment or services or on a •resent or•endin•
award for goods,equipment or service?
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
D velopment Issues":
_Yes o: Are ou lobb in• on a •endin• a.•lication for a Develo•ment A.reement with the Cit or a.•lication 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
co I pensation or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition to any
it m,shall register with the clerk as required by this section but,shall not be required to pay any registration fees.
Yes o: Are ou re.resentin• a not-for-.roft cor.oration or entit without s•ecial com•ensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE C, CLERK A SIGNED STATEMENT UNDER
OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPEN : •• REC ED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL B ED EV A1 RE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PEA �,l
Signature. -••• .t
I do solemnly swear that all of the fore.,ng fa is are true and correct and th-t I have ead or am familiar with the provisions contained
in Section 2-482 of the Miami Be- -,i-y- Co. =•• -II reporting requirements.
, .■
Signature of Lobbyist: / 1
Signature of Principal/Client: :i/i V�v_ i_..si I
VI. LOBBYIST IDENTIFICATION: Dm^ PRINCIPAL IDENTIFICATION: 1
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Produced ID I � UO�—';*z o •.iv a,`, Produced ID r`� bRivegS (,J C-
Form of Identification , ?,pro QQ Form of Identification
ymy � ,�
Personally known (Lobbyist) ,;�-_ �'�.oc 4- Personally Personally known(Principal) coo .. o .s,
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VII. SIGNATURE AND STAMP OF NOTARY: i/SI�V� c;"eti Wes ?
State of Florida, County of Miami-Dade ..••n••� r,• State of Florida, County of Miami-Dade d , ;°
�.�`�,c .''dry a -o c
Sworn t. .nd subscribe• befor_ me -�� S, i subscrib-d befgre me a� ``' g r S.
•This • , .=y of 'iv t . , 01: E. r .,,. r • day of A .Rc1 , 201_ . ' I °'■
et,4111111111K-,_....' A Signa re of Public Not . tate of Florida Signa ure
ditk , ' . -.1. 1---of Public Notary—State of Florid 0'Vc••:'''•,, ec.
Notarizati• of Lobbyist's signature Notarizati in of Principal's signature 2`f::'.`%
TO BE COMPLETED BY ITY CLERK'S STAFF ONLY =,s" i f
Annual Registration fee: [ Yes[ ]No Amount Paid$ "4m — MCR# I/O3(,�g7 Date Pal. - iJ
Lobbyist Registration Form received and verified by: ,_ _ _
F:\CUR\ ,A1.3.1afORMS\LOBBYIST_FORMS\Lobbyist Annual Regi ra.on Form.doc Revised 01/ 2/2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granada, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.741 1 ,Fax:305.673.7254
LOBBYIST N4� E. Hi'W /4 6/ 101)
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 of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.S;v9S-
4041000
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Sign. r' ;''
ate:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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Camm, Patrick
From: Marc Halpern <mhalpern @hrllplaw.com>
Sent:. Wednesday, April 29, 2015 10:15 AM
To: Camm, Patrick
Subject: Lobbyist registration form
Patrick:
Apologies for the confusion. I was representing/lobbying on behalf of 1500 Ocean Drive Condominium
Association, Inc. The president of the Association is Michael Berman.
Please let me know if any further information is needed.
Marc A. Halpern, Esq.
Halpern Rodriguez, LLP
Douglas Entrance,North Tower
800 Douglas Road, Suite 880
Coral Gables, Florida 33134
mhalpern@hrllplaw.com
Phone No.: (305) 442-8883
Fax No.: (305) 443-1880
This e-mail, and any attachments thereto, is intended only for the use by the addressee(s) named herein and may
contain legally privileged and/or confidential information. If you are not the intended recipient of this e-mail,
you are hereby notified that any dissemination, distribution or copying of this e-mail, and any attachments
thereto, is strictly prohibited. If you have received this e-mail in error, please immediately notify me by
telephone and permanently delete the original and any copy of any e-mail and any printout thereof.
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