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Carli Koshal - Steve Cerrato 95ø per 4., Ave. p 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 p rocess on such action, decision or recommendation t hat f oreseeably will b e h eard or r eviewed 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. Koshal Carli NAME OF LOBBYIST: (Last) (First) (M.I) Bercow Radell & Fernandez, PA 200 South Biscayne Blvd., Suite 850 Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 374-5300 (305) 377-6222 ckoshalcbrzoninglaw.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: Steve Cerrato NAME OF PRINCIPAUCLIENT: 4560 Sheridan Avenue Miami Beach Florida 33140 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 776-0704 Stevecerrna gmail.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: 101 pc • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II.SPECIFIC LOBBY ISSUE: Development Board Approvals for 4560 Sheridan Avenue,Miami Beach, Florida Issue to be lobbied(Describe in detail): Ill. 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 C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc �1 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 p rocess on such action, decision or recommendation t hat f oreseeably will b e h eard or r eviewed 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. Koshal Carli NAME OF LOBBYIST: (Last) (First) (M.1) Bercow Radell& Fernandez, PA 200 South Biscayne Blvd., Suite 850 Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) , 3Q)374-5300 (305)377-6222 ckoshal brzo in law com TELEPHONE NUMBER: FAX NUMBER: EMA L: Please notify this office if your contact information changes:address,phone, or e-mail address, I. LOBBYIST RETAINED BY: Steve Cerrato NAME OF PRINCIPAUCLIENT: 4560 Sheridan Avenue Miami Beach Florida 33140 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 776-0704 Stevecerr(&gmail.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: o( - IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,.A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: ii.SPECIFIC LOBBY ISSUE: Development Board Approvals for 4560 Sheridan 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(9)Any Financial,Familial or Professional Relationship i E C:(Users\clerhatl\AppData\LocaRMicrosoft\Windows1Temporary Internet Files\Content.Outlook183LGQDDH1Lobbyist Registration' Formrevised 5-30-2012.doc LaRosa, Clara From: Diana Ramos <dramos @brzoninglaw.com> Sent: Monday,July 06, 2015 1:50 PM To: LaRosa, Clara Subject: FW: Cerrato, Steve Attachments: SKMBT_C36015070612470.pdf Section 2-482 (g) -any financial, familial or professional relationship - NONE VCARD DIANA RAMOS ASSISTANT TO GRAHAM PENN, MICKEY MARRERO &CARLI KOSHAL BERCOW RADELL& FERNANDEZ, P.A. 200 South Biscayne Boulevard, Suite 850 Miami, Florida 33131 (305) 377 6239 OFFICE (305) 377 6222 FAX DRAMOS @BRZONINGLAW.COM B E.RCOW RADELL&FERNAN DEZ ZONING. LAND USE AND ENVIRONMENTAL LAW WWW.BRZONINGLAW.COM From: Diana Ramos Sent: Monday,July 06, 2015 1:42 PM To: 'claralarosa @miamibeachfl.gov' Subject:Cerrato,Steve Ms. LaRosa, Section 2-482 (g)—NONE Please let me know if ou have any questions. Y Yq Thanks, Diana Ramos 1 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $260 B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED). $260 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 X No: Are you lobbvina on a present or oendina 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 X No: Are you lobbying on a pending application for a Development Agreement with the City or application fa change of zonina map desianation or chanae to the City's Future Land Use Mao? 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 X No: Are you reoresentina a not-for-profit corporation or entity without special compensation or reimbursement, 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. A S WELL A S COMPENSATION RECEIVED. IN THE CITY OF MIAMI BE AC.H EQE, THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPO0 NG PERIOD. Signature of L bbyist 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 City Code -nd all rep- ing requirements. Signature of Lobbyist: C.,. • r Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ,s.,„ /Produced ID Produced ID L D L . Form of Identification limos? Form of Identification 1,,. vbA• f Personally known (Lobbyist) K Q Personally known (Principal) m L13 I ill VII. SIGNATURE AND STAMP OF NOTARY: B �' g. Stat- �f Florida, County of Miami-Dade �$ State of Florida, County of Miami-Dade m N it to Sworn t• an. bscribe gfore me N g, worn�'1,d subscribe before me , e a Thi•' L't ..y of ...WI , 201.36 a s his , I_,` day of tJ , 201. \Ilik, it, I Signat 7e of P.blic Notary—State of Florida Signature o` 'ub is Notary—State of Florida Notarii ion oA.-obbvist's signature Notarizatib of "rincipal's signature TO BE COMPLETED.BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ 50 °t MCR# "-t0 �3el Date Paid 7 17/1 Lobbyist Registration Form received and verified by: -:w . C:\Users\clerhatlWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc F: Revised 04/27/2012 i S City y of Miami Beach, 1700 Convention Center Drive. Miami Beach, Florida 33139. www.miamibeachtl.gov CITY CLERK Office Rafael E. Granado, City Clerk CityClerkru`;:miarnibeachtl.gov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: Carli Koshal 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 t o 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. • •, , A -lc.c j HS Signature: Date: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc (la kilita IgallmgllVMPXIIIIIIMIIIIINIRIPWRIRIW mmmmosimmommwmmmmmw City of Miami Beach-Florida Finance Department 1 City Hall 1518720-2 07/06/2015 BR1 T137 Mon Ju106,2015 02:20PM Trans#7-7 7 $350.00 MCRCLERK - MCR-City Clerk * MCR#: 404839 1 ITEM(S): TOTAL: $350.00 Check (001355) PAID $350.00 Have a nice day! , ,t r t �i► 3 eane� s Cash:Re eipt � i _ s �M 1l El Cash ❑Credit Card Check:# 1 3 $ t ( 20 1 ,j j Received Of_ --?Address j For -- I') i-1 ,' _ '''::,1 ...'::;_l:::1:‘.1'1_1.:,'1.,_:.--.',::.''.,tr ri.0*, NATION MUST:BE COMPLETED) Office®f Finance Director Sa r-LM i ¢ ( B�',...„,.:::._..,,-.: : ,,. __._.: . ,-....:::._._ ,. .: ,,,- .,:., .,.. _:_: .y_.:i i ,-.. :.Account Number:, r- 6 - _ -� - Pr®parer: .�.:: f Dept -, _ r ,, ., :EX.. .1 :ar h - r-.A. -'!.-r -::._..� t.a _nF(.N 1 .i.. —..w,:i- h("�.. rte...l.., .✓ -1G 1.•3!c . . .. . _ r. ..n, ....I.J ..Y . .4 7.1