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Monika Entin - South Beach Synagogue, Inc.
6ZCI Lew©Y MIAMI BEACH F� � : City of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 332t.3 HA b ° 05 LOBBYIST REGISTRATION FORM l i i `+ > OFFICE. 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(aBRZoni naLaw.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: Sharone Lankru NAME OF PRINCIPAUCLIENT: South Beach Synagogue, Inc. D/B/A Shuva Israel South Beach, 629 Lenox Avenue, Miami Beach, FL 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (786)281-0284 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:Sharone Lankry (®pf10 • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: NON-PROFIT II.SPECIFIC LOBBY ISSUE: Development Approvals and Permitting Issues, including, but not limited to the Historic Preservation Board, Design Review Board, Planning Board, Board of Adjustment, Land Use Development Committee, City Commission, and any City Workshops or Committees, if necessaru. relating to the propertu located at 629 Lenox Avenue. 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 Department and Building Department Staff None. X PB, 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 None_ None None. C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc 1 c- IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $ 1(D V/7/c.)r B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): `z1f�'' . ''. 464//C07/1 (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 Flo: Are you Iobbvina on a present or nendina bid for aoods.eauipment or services.or on a present or pending award for aoods.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)(No: Are you Iobbvina on a nendina application for a Development Aareement with the City or application for chanae of zonina man 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. .Y 2::$ , ., - • -• . • . 1 •1• 1• • .• • • ••r. .• 1 S - 1 , ' 1. - a- ... •11 •- 1 ' . ••I • -•11 • :!`'11 1 V. SIGNATURE UNDER OATH: ON FEBRUARY 28 OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED STATEMENT UNDER OATH. LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATION RECEIVED. IN THE CITY OF MIAMI BEACI-1 Egg THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO f)CPENDITURES OR COMPENSATION DURING THE REPORTING_PERIOD, Signature of Lobb I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach C. -Code-Ord-all-reporting requirements. Signature of Lobbyist: 16.1./A ■7 . Signature of Principal/Client: _V"— /` l%k war- VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Produced ID ✓Produced ID r(, bcz4vc-42 c-cc€SE Form of Identification . --,t64,••.°4;$ Form of Identification uLSd.(9. 3- 3?f-0 4Personally known(Lobbyist) ,:. o Pe�,;., :-,Y n l C 3 -. STATE OF FLORIDA VII. SIGNATURE AND STAMP OF NOTARY: ;, N. 3 Q,°„ f ^I - r 01 Comm#FF209948 State of Florida, County of Miami-Dade y State of '' `, C Expjr®d 3 the Sworn • and subscribed before me .. "' Swo n and subscribed before me 30 This i i 41 04,01(11 II Vii .I-,A ,2015 cs 0 s T l d of I�A� , 2015 CO 4.11 Signatu e of ' '• ' otar -State of Florida ao Signature PP lic Notary-State of Fl rida Notariz=tion i o•bvist's signature — Notarization of principal's signature 9 P g TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration tee: [ ]Yes[ J NO Amount Paid$ Li 1T7 NICK# .7 > Date Paid 5 Lobbyist Registration Form receive4and verified by ,, M I AM I BEACH 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 Miami-Dade County Commission on Ethics and Public Trust. Signatur:• D te: C:\Users\clerhatl\ppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc M6scelianeous Cash Receipt : ; ,. .:..:1. ... _ 4,-14..;. �1-7.-d .;.K:1 :. ;: CITY OF MIAMI BEACH �, .4 t / =;- No .j j I ^ (.7 V El Cash El Credit Card Check# 1 6'I $ -, 'L' ' s _ ,1 2 20• Received of / i 1 Address /. (---A-; ,, '=---.4/01/4../0 t. -;I v U For (-2 1...1 + X- t,i tj � 4. . I - -)L _ . ((THIS INFORMATION MUST BE COMPLETED) Office of Finance Director By Account Number: 011 So 0 0 - 7 6 9-Lri LA Preparer: (- �_a Dept:, . ( ( ---L( ((e( k , ) ,,i. 1 = n _. 9, --� cu C CD C- ~--4 n CD r-r 0, X-rr7 �J ff} 3 OD n = `G # CDOO M O C O O N ' CD '• O . OD 3 CD O - MONO Lj;' -I -�1 3 Cr N r�i • -0D ,D -, 07 @ OD . G EP) m c.n [n ? 3 a7 O O 3 _--s CD Cr) . 1 C7 OD CD I