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Jeffrey Bercow - Gumenick Family Investment No. 2 G15c Oz-sE- AuQ,. RECEIVE® FEB 12 2020 Office of the City Clerk 'BE I< 1700 Convention Center Drive CITY OF HEM iv CLERK Miami i.Beach, FL 33139 OFFICE 305.673.7411 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 modificationof.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, decisionor 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.City Code Chapter 2, Article VII, Division 3, entitled"Lobbyists,". for additional information. Instructions: Please complete all sections of this form and submit the completed form,with the applicable fee, to the Office of the City Clerk. If you need morespace to complete an answer, use a separate sheet(s) of paper. If you have nothing to report in a particular section, you must write "none" or "n/a" in that section. Any change to any information originally filed, or any additional. City Commissioner or personnel who:are'also sought to be lobbied shall require that the lobbyist file an amendment to the registration form. The lobbyist has a continuing duty to supply information and amend the forms filed throughout the period that the lobbying occurs. Separate registration forms shall be required for each principal represented on each specific issue. I. LOBBYIST INFORMATION: ' Bercow ', Jeffrey NAME OF LOBBYIST , (Last)' (First) (Middle Name) Bercow Radell Fernandez Larkin&Tapanes, PLLC 200 South Biscayne Blvd., Ste. 850 Miami,Florida 33131 LOBBYIST BUSINESS NAME AND ADDRESS. (Number and Street) (City) (State): (Zip Code) (305) 374-5300 jbercow@brzoninglaw.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER ' EMAIL ADDRESS II. PRINCIPAL INFORMATION: Gumenick Randy NAME OF PRINCIPAL (Last) (First) (Middle Name) Gumenick Family Investments No. 2 4901 Libbie Mill East Blvd., #200 Richmond VA 23230 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) snash@gumprop.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE.NUMBER EMAIL ADDRESS Pursuant m ft(gat Section 2-482(h)(1)(a): a principal dIQ J corporation, partnership, CI?CiD-P 7 appears Epp lobbyist Cla=ET CIRD15 AIM without special compensation Cly reimbursement for for gp�laxI�aotAindirect,CP contingent,137 mum ••• CACP 0.eosition(I OE aliii Ella resister the(gthEi3 re.uired[DM subsection MEW D R 3Ce7I re.uired QCIIKWE39 re•istration g2Ga If the principal is a Corporation, Partnership or Trust, the following information MUST be provided pursuant to City Code Section 2=482(c): • d NAME OF CHIEF OFFICER, PARTNER,OR BENEFICIARY(if none,write N/A): Randy Gumenick • NAME OF ALL PERSONS.HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN,SUCH CORPORATION,'PARTNERSHIP OR TRUST(if'none,write N/A): See Attached. Page 1 of 50 I. ISSUE TO.BE LOBBIED: Describe withas much detail as is:practical, including but not limited toa specific description where: applicable of a pending request for proposal, invitation to bid, or public hearing number. Development Approvals &Planning Issues, including but not limited to the Historic Preservation Board, Design Review Board,Planning Board, Board of Adjustment, Land Use Development, City Commission, and any City Workshops or Committees,if necessary,relating to the;property located at 959 West Avenue in Miami Beach,Florida. IV. CITY AGENCIES/INDIVIDUALS TO.BE LOBBIED: Pursuant to City Code Section 2-482(a)(4), list the City Commissioner or City personnel sought to be lobbied,:and whether the:lobbyist has entered into any contractual relationship. (paid or unpaid) with said:City Commissioner or City personnel:from:12 months preceding such commencement of service with the City to the presentdate,stating.the.general nature of the subject contractual relationship. Full Name of Individual and Contractual Relationship (If yes, explain) YES . NO Title of Person to be-Lobbied Staff for the.Planning&Building Department None X Public Works&City Administration,PB,HPB, BOA None X DRB, City Commission, and Mayoras 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,. orother 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 registrationform filed. . . List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an appearance of impropriety (if none,write N/A): None . V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION Be Specific. (Note that a contingency fee is prohibited pursuant to City Code Sec. 2-485.3): $725.00 per hour • Page.2 of 5 The following six.(6)questions MUST be answered: 1) Pursuant to City Code Section 2-488,entitled"Prohibited Campaign Contributions By Lobbyists On Procurement Issues": '_Yes XNo: 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 City Code Section 2-490, entitled "Prohibited Campaign Contributions By.Lobbyists:On Real Estate Development Issues": _Yes XNo: 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 City Code Section 2-482(h), any person (except.those exempt from the definition of "lobbyist" as set forth in Section 2-481)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 city clerk as required by thissection,,butshall not be required to pay any registration fees. Yes X No: Are you: representing .a .not-for-profit .corporation. or.entitywithout special: compensation' or reimbursement? 4) Pursuant to City Code Section 2-481, the term "lobbyist".specifically excludes the following persons: Expert witnesses who provide only scientific, technical or other specialized information or testimony in public meetings; any person who only appears as a representative of a neighborhood associationwithout compensation or reimbursement for the appearance,whether direct, indirect or contingent,to express support of or opposition to any item;and any person who only appears as a representative of not-for-profit community based. organization for the purpose of requesting a, grant without special compensation or reimbursement for the appearance. Yes No: Are you 'providing only scientific, technical or other specialized information;.appearing as a .. representativeof a neighborhood association without special compensation or reimbursement or representing-a not-for-profit based organization :for'the .purpose of requestingagrant without special compensation or reimbursement? ' 5) Pursuant to City Code Section 2-491(1), no campaign consultant shall lobby the City Commission for a period of 12 months following the swearing in of any elected official(s) for whom the campaign consultant provided campaign consulting services within the past election cycle. See Section 2-491 for more information. —Yes XNo: Have you provided campaign consulting services to an incumbent member of the City Commission within the past election cycle?If yes, please list the incumbent member(s)of the City Commission: Yes XNo: If yes, has it been less than 12 months since the elected official(s) whom you provided campaign. consulting services was sworn ins. 6): Pursuant.to:City Code Section 2-482(a)(4)a., a lobbyist who has within the past election cycle provided campaign consulting services to an incumbent member of the City Commission:(which lobbying:activity is not otherwise prohibited by Code section 2-491) shall disclose such particular service on his/her lobbyist registration form_and shall orally disclose such particular service before lobbying the City Commission at a public meeting. _Yes XNo: Have you provided campaign consulting services to an incumbent member of the City Commission within the past election cycle?If yes, please list the incumbent member(s)of the City Commission: • Yes XNo: If yes, were you promised or did you receive economic consideration in exchange for campaign — consultimq senrices� — - TO BE COMPLETED BY CITY CLERK'S STAFF47-6 ONLY:. 4-6 Annual Registration•fee: [ ]Yes • ]No Amount Paid$ S MCR'# I-l 7- Date Paid, 0 t1- Lobbyist Registration Form received and verified by: e-Y i✓kaLErre$'n,LLVIFaRK:MO,risaSir'FORMS\Vol)hrstt egisrrarion Fng rn Remised oP-z6-18 Revised 09/20/2018 Page 3 of 5 VI. SIGNATURES UNDER OATH: ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK.A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, FOR THE PRECEDING ENDAR YEAR WITH REGARD. TO THE SPECIFIC ISSUE ON WHICH THE. LOBBYIST HAS BEEN ENGAGE' 0 OBBY..A TEMENT SHALL-BE-FILED E. EN IF THERE HAS BEEN NO EXPENDITURE OR COMPENS' '10 DURING EPORTINGP RIOD.� el Signature of Lobbyist: Ad' Date h w I do solemnly swear or affirm at -II of.the f• e••ing.facts, stateme• s, and disclosures in this form are true and correct, and that'I have read or am amili-r with th= pr.•.'sio s 'ntain:• in Chapter 2, Art. VII,'Division 3, entitled "Lobbyists" of the.Miami Beach City Cod: and - I reporti r g :-'•; -r,,-. Signature of Lobbyist: Ale // / / Date 2 fi 20 Signature of Principal: Date Zic reP VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State.of CAOY>act State of .TWA da County of: CAA nwtti - C'Ac e. County of:. d\S-- Sworn to (or affirmed) and subscribed before me Sworn.to (or affirmed).and subscribed before me this 12- day of F:el vvA.r4 , 202 by t'Randolph his(�6 day. of PJbl >� , 202P by Jeffrey TT OW 'Ra' K/'o1p I b0r 1 k NAME OF LOBBYIST U� S Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION x Per onally:Known. Personally:Known. '.igna •lit ` Notary Public Signature of Notary Public bet i � . - 5 G i th 1 aq2�S Name of Not'ar i Typed,Printed or Stamped Name of Notary, Typed, Printed br Stamped. , F:'�:4 ., BEITYLLERENA . i ,, MY COMMISSION i GG 175999 i :fir"r�•. SAME MLAYES x (NOT.RN' (NOTARY SEAL) ,7——. EXPIRES:March 5,2022 i�; �� NotaryPublic Stite of Florida g ..i .. god11� , Underwriters i 0 ? d� Commission yGG 211957 l 1''•..,••a F;,:` My Comm.Expires Apr 29,2022 i ' Bonded through National Notary Assn. I 1 The term"lobbyist'specifically excludes the following persons: Expert witnesses who:provide only scientific,technical or other specialized information or testimony in,public meetings; any person who only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether direct, indirect or contingent, to express support of or opposition to any item; and any person who only appears as a representative of not-for-profit communitybased organization for the purpose of requesting a grant without special compensation or reimbursement for the appearance. . Page 4 of 5 MI AM:BEACH: : City of Miami Beach,:1700.Convention Center Drive,Miami.Beach;Florida 33139,www.miamibeachfl.gov Office of the City.Clerk Rafael E.Granado;City Clerk City.Clerk@miamibeachfLgov Tel:305.673.741.1.;Fax:305.673.7254. NAME OF LOBBYIST: Jeffrey Bercow 1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT Pursuant to City Code Section 2-485(d), the City Clerk shall notify any lobbyist (or principal) who fails to file timely a Lobbyist Fee Expenditure and Compensation Statement (Statement). In addition to. any other penalties that may .be imposed: as provided in Section 2-485.1, a fine of $50.00 a day shall be assessed .for Statements 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 appealedto the.Miami-Dade:County Commission on Ethics and Public Trust. I herebyacknowledge that on February 28 of each year, I shall submit to the City Clerk a signed Statement under oath listing all .lobbyist expenditures, as well as compensation received, for the preceding calendar yearwith regard to the specific issue on which I have been engaged to lobby. 2) LOBBYIST WITHDRAWAL . Once an. issue I have registered to lobby, has concluded or I am no longerlobbying on that issue, I shallimmediately filea:Notice of Withdrawal with the Office of the City Clerk. 3) ANNUAL LOBBYIST REGISTRATION FEE I understand annual registration of all lobbyists shall be required for-each .12-month period corn.- -ncing. Oc e •- 1 of .each year, and the fee for such.annual registration shall: be S. iO.'0 pursu. • " -ction 2=4: . the Miami'Beach City Code. ji 1/4 d Sign7r. e o Lobbyist D to F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Page5of5 Gumenick Family Investments#2,Ltd., a Florida limited partnership c. A,U / Limites Partners: JRG Investments,LLC(44.550%) Jeffrey H. Gumenick(22.275%) Randolph S. Gumenick(22.275%) Wayne A. Chasen(10.000%) General Partner: Gumenick Investment#2,LLC(0:900%) 0.900% 22.275% 22.275% 44.550% 10.000% Gumenick Investment#2,LLC,a JRG Investments,LLC,a Florida Florida limited liability Jeffrey H.Gumenick Randolph S.Gumenick limited liability company Wayne A. company Sole Member: Chasen J&R Holdings,LLC(100%)'\ Members: Co-Managers: J Jeffry H.Gumenick,Randolph S.Gumenick Jeffrey H.Gumenick 1^ and Walter F.Witt,Jr.,as Trustees under the - Jeffrey H.Gumenick Family Trust Agreement Randolph S."Gumenick I,FD ç&( dtd 6/20/07 And Jeffrey H.Gumenick,Randolph S.Gumenick and Walter F.Witt,Jr.,As Trustees under the Randolph S.Gumenick Family Trust Agreement dtd 6/20/07 Management Committee: Jeffrey H Gumenick Randolph S.Gumenick Walter F.Witt,Jr. Wayne Chasen L e5�.( ,ddre.) t°1 o. (IS nL C6/51;e, gr .3, o..-. dc.c) Mat ac Ffee-fwood Sv01,;(sccn c recCPdcoJ ►A e& 2a-aY SOUTHGATE TOWERS,LLLP, a Florida limited liability limited partnership Limited Partner: Gumenick Family Investments No. 3, Ltd.,a Florida limited partnership(99%) General Partner: Gumenick Investment No 1, LLC, a Florida limited liability company(1%) 1%° 99% Gumenick Family Investments No 3,LTD a Florida limited partnership Gumenick Investment No. 1,LLC,a Florida limited liability company Limited Partners: Jeffrey H.Gumenick(2.2176%) Sole Member: J&R Holdings,LLC Randolph S. Gumenick(2.2176%) JRG Investments,LLC, a Florida Managers: Jeffrey H. Gumenick limited liability company(94.5648%) Randolph S. Gumenick General Partner: Gumenick Investment No 3,LLC,a Florida limited liability company(1%) < < - 1% 94.5648% 2.2176% 2.2176% 100% J&R Holdings,LLC,a Florida Gumenick Investment No.3, JRG Investments,LLC,a Florida limited liability company LLC,a Florida limited limited liability company Jeffrey H. Randolph.S. Members: liability company Gumenick Gumenick Randolph S.Gumenick General Partner Members: Jeffrey H.Gumenick Jeffrey H.Gumenick,Randolph S.Gumenick Management Committee: Sole Member: J&R Holdings, and Walter F.Witt,Jr.,as Trustees under the Jeffrey H.Gumenick LLC(100%) Jeffrey H.Gumenick Family Trust Agreement Randolph S.Gumenick dtd 6/20/07 Walter F.Witt,Jr. Managers: Jeffrey H.Gumenick And Wayne A.Chasen(also Randolph S.Gumenick Jeffrey H.Gumenick,Randolph S.Gumenick listed as President) and Walter F.Witt,Jr.,As Trustees under the Randolph S.Gumenick Family Trust Agreement dtd 6/20/07 Management Committee: Jeffrey H Gumenick Randolph S.Gumenick Walter F.Witt,Jr. Wayne A.Chasen Miscellaneous Cash Receipt CITY OF MIAMI BEACH No.425720 0 Cash ©Credit Card Check# 'f -. 11 1. $ -700 t 'O 20 `:10 RRYved.of ..L Miscellaneous-MCR-2O2U c 1t • Z < ,' , ,A z .r FoiCR OPEN(MCR) y ('j. 9`'a 11 5') +C) ri Payment Amount: 700.00 MCR425720 . ' (THIS INFORMATION MUST BE COMPLETED) Office of Finance Director By Account Number: 01 Cf, 'li�( LI , ,�� -30*'7 � 1 _ G'). Preparer: .�PO') .;a,�t f k.- Dept: C En:-7 I i I