Graham Penn - Myles Chefetz • 153 Co lk ns
MIAMI BEACH -�
City of Miami Beach Office of the City Clerk, y • h '
1700 Convention Center Drive, Miami Beach, FL 33139 �'i l: C O
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks tolencourage 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.
Penn Graham
NAME OF LOBBYIST: (Last) (First) (M.I)
Bercow Radell &Fernandez, PLLC, 200 South Biscayne Boulevard, Suite 850, Miami, FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-3 77-6229 305-377-6222 apenn(aBRZoninaLaw.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:
Myles Chefetz
NAME OF PRINCIPAUCLIENT:
157 Collins Avenue, LLC 157 Collins Avenue, Miami Beach Florida 33139
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: Mlles Ghee
- IDENTIFY PARTNERSHIP OR TRUST: C
PERSONS HOLDING, DIRECTLY ECTLY OR INDIRECTLY 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
II.SPECIFIC LOBBY ISSUE:
Development Approvals and Permitting Issuesl including, but not limited to the Historic Preservation Board, Design Review
Board,Planning Board,—Board of Adjustm the Land Use Development Committee, City Commission, and any City Workshops or
Committees, if necessary, relating to the nronertu located of 53-Collins„ Mic im Beach. Florida.?
Issue to be lobbied(Describe in detail): —'
ul. 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
Staff for the Planning Department, Building Department, None. X
Public Works and City administration, PB, HPB, BOA, None. X
City Commission, and Mayor 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
Non 6r!
None.
None.
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration .j
Formrevised 5-30-2012.doc fr
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) 41440 p ill
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): 4i) Ql it
(REQUIRED). I
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,equipment or services,or on a present or pending
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
Development Issues":
_Yes N_Jo: Are you lobbying on a pending application for a Development Agreement with the City or application 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
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.
_Yesco: Are you representing 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,AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHA ILED EVyN IF 'HERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD.
Signature of Lobbyist
I do solemnly swear that all - foregoing fa•/s are true and correct and that I have read or am familiar with the provisions contained
in Section 2-482 of the Mi. ii T-:c i► od- and all reporting requirements.
Signature of Lobbyist!' \\\ 1� -
Signature of Principal/Client: / 4
VI. LOBBYIST IDENTIFICAT cr/ i PRINCIPAL IDENTIFICATION: amigo
� /Personally 23-Produced ID Produced ID g 3 m Q`/ Form of Identification . Form of Identification o g• Tam 6 `or 4 Personally known(Lobbyist) a 3 m _ known(Principal) '
3 13
VII. SIGNATURE AND STAMP OF NOTARY: o 1 . iO 1
N N
State of • ida, C unty of Miami-Dade T m -tate Florida,County of Miami-Dade
Sworn ld sub rib d of re me �t or nd subscribgdbef re me
This di •a of 201 day of rt� ,201ip
Signature of " 1•Iic Notary—State of Florida - Signature •f l'ublic Notary—State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes 04 No Amount Paid$,71470.ae MCR# L4 C�'9'�J Date Paid �/i.�l1‘
Lobbyist Registration Form received and verified by: .y,,.rw,;,
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 01/22/2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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.
MIAMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachtl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LO B B Y IS T NAME Graham Penn
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
appeale• • e Miami-Dade County Commission on Ethics and Public Trust.
4011W. /1/2 cD/
Signature: Date:
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Form revised 5-30-2012.doc
Miscellaneous Cash Receipt
CITY OF MIAMI BEACH No. 409981
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❑ Cash ❑Credit Card ECheak# " c- -' $ • .. j. /
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MCR OPEN For L / a _+ i.�' `�`-: i!'iri. /... ,•,. - ) t,. . f } i s- , ,,!; 1 t ,,,,
Payment Amount: E- 1.3,50;00 i ti I, " ,)
409981
(THIS INFORMATION MUST BE COMPLETED) Office of Finance Director
By p)9-
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Account Number: ( ` y `� '
`i Preparer. Dept: (. t /",',� , ' EXT. `f r?
BIG PINK, INC. 84233
CITY OF MIAMI BEACH 6/8/2016
Date Type Reference Original Amt. Balance Due Discount Payment
6/8/2016 Bill 06.08.16 350.00 350.00 350.00
Check Amount 350.00
Wells Fargo Operatin Lobbyist 350.00
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