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Jeffrey Bercow - Marina Park, LLC.
3cx7- 3N ,� mAl2_,,,, RECEIVED /\AI,4JIBEAC fri JUN 12 2020 Office of the City Clerk 1700 Convention Center Drive CITY OF MIAMI BEACH Miami Beach, FL 33139 OFFICE OF THE CITY CLERK 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 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 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 more space 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 S.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: Martin David NAME OF PRINCIPAL (Last) (First) (Middle Name) Marina Park,LLC 2665 S. Bayshore Drive,Suite 1020 Miami Florida 33133 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) • (State) (Zip Code) (305)416.4556 david@terragroup.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS Amman I l I@ x b Section 2-482(h)(1)a): t I i••I OM corporation, partnership,01 Gatitt VAlla appears aZi E lobbyist Cal I C:O i MU without special compensation a?rei •ursement fortI1 appearance,SplkoatuR,indirect,01 contingent,ti,7 G ••• CQCQ o•.osition(ia mi ii l[ cite(ii G'a the ESIDeZi - •sWaYfilbiar13281aUghgazilExa re.aired Q7( 37 FA7 If the principal is a Corporation, Partnership .or Trust, the following information MUST be provided pursuant to City Code Section 2-482(c): • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY(if none,write N/A): see attached • 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 5 Ill. ISSUE TO BE LOBBIED: Describe with as much detail as is practical, including but not limited to a specific description where applicable of a pending request for proposal, invitation to bid, or public hearing number.: Lease Amendment and Extension and related Matters regarding Miami Beach Marina located at 300-344 Alton Road 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 present date, 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 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. 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 p/h 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 ,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 City Code Section 2-490,entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": X Yes_No: 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 this section,but shall not be required to pay any registration fees. _Yes Z(No: Areyou representing a.not-for-profit corporation or entity without 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 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 community based organization for the purpose of requesting a grant without special compensation or reimbursement for the appearance. _Yes xNo: 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 CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO EXPENDITURE OR COMPENSATION DURING THE REPORTING PERIOD.' Signature of Lobbyist: Date I do solemnly swear or affirm that all of the foregoing facts, statements, and disclosures in this form are true and correct, and that I have read or am familiar with the provisions contained in Chapter 2, Art VII, Division 3, entitled "Lobbyists" of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Date Signature of Principal: Date -512i/2-0 2.4-) VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of State of � rJ Gam, County of: County of: I ant/. ' Sworn to(or affirmed)and subscribed before me, Sworn to(or affirmed)and subscribed before me, by means of 0 physical presence by means of 0"physical presence or 0 online notarization, or 0 online notarization,. this day of ,20_,by this day of 20_,by Jeffrey Bercow David Martin/Marina Park,LLC NAME OF LOBBYIST NAME OF PRINCIPAL Produced ID Produced ID, FORM OF IDENTIFICATION z FORM OF IDENTIFICATION _Personally Known 4 Personally Known Signature of Notary Public Signatyre • otary r ubbti e i .. Name of Notary,Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped (NOTARY SEAL) (NOTARY .1;yir ode., SANDRA MARIA RAMOS 'k-CrNotary Public-State of Florida �' o: Commission a GG 944633 1 „ I My Comm.Expires Apr 30,2024 The term lobbyist specifically excludes the following persons: '' 'of"" Bonded through National Notary Assn.• ' 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,community based organization for the purpose of requesting a grant without special compensation or reimbursement for the appearance. Page4of5 uuauoIyn uiv lupe Iu.MooDau MeV 10I-4wu"-,3 %-.rct,I IDDC.wu 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 CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO EXPENDITURE OR COMPENSATION DURING THE REPORTING PERIOD.' Docusigned by: 5/22/2020 Signature of Lobbyist: El.,, „iDate A2E6CDA40FB3455... I do solemnly swear or affirm that all of the foregoing facts, statements, and disclosures in this form are true and correct, and that I have read or am familiar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of the Miami Beach City Code and all reporting requirements. DocuSigned by: Signature of Lobbyist: Eli OV Date 5/22/2020 / Signature of Principal: A2E5cDA40FB3455... Date VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of Florida State of County of: Miami-Dade County of: Sworn to(or affirmed)and subscribed before me, Sworn to(or affirmed)and subscribed before me, by means of 0 physical presence by means of 0 physical presence or li online notarization, or 0 online notarization, this 22 day of May , 20 2Q by this_day of , 20 , by Jeffrey Bercow David Martin/Marina Park,LLC NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION x Personally Known _Personally Known Signature of NotaryL�.,m I Signature of Notary Public 9 Diana Ramos Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped (NOTARY 1Diana Ramos (NOTARY SEAL) Commission#GG 308355 i Notary Public-State of Florida My Commission Expires Apr 10,2023 I The term"lobbyis, 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 community based organization for the purpose of requesting a grant without special compensation or reimbursement for the appearance. Page 4 of 5 uuuuoiyu cnvewpe w.C0000u I�.-u I a 1-4.1.urr+our0rel•I t ooCoou MIAMI - EACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachH.gov Office of the City Clerk Rafael E. Granado, City Clerk CityClerk@miamibeachfl.gov Tel: 305.673.7411, 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 appealed to the Miami-Dade County Commission on Ethics and Public Trust. I hereby acknowledge 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 year with 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 longer lobbyingon that issue, I shall immediately file a 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 commencing October 1 of each year, and the fee for such annual registration shall be $500.00 pursuant to Section 2-482 of the Miami Beach City Code. �DocuSigned by: Z 5/22/2020 P,2c0coA4orn34 C... Signature of Lobbyist Date F:ICLERI$ALL1aFORMSILOBBYIST FORMS1Lobbyist Registration Form Revised 03-11-20 REG.doc Page 5 of 5 Disclosure of Interest Information Principal: Marina Park, LLC, 2665 South Bayshore Drive,Suite 1020;Coconut Grove, Florida 33133 Name of Chief Officer, Partner or Beneficiary:Alton Mixed Use Investments Holdings, LLC, as its sole member Name of All Persons Holding, Directly or Indirectly, a'5%or more ownership interest in Marina Park,LLC: 1.Alton Mixed Use Investments Holdings Member I, LLC 2. RCI MBM Developer, LLC 1*-"A (\ doclerify t e � 40 A o°CVEP‘i Lobbyist_Registration_Form_J._Bercow_V21.pdf DocVerify ID: 8D53D91 C-4CCB-4C27-9D3E-38BD1950A00E Created: May 22, 2020 06:46:36 -8:00 Pages: 6 Electronic Notary: Yes / State: FL This document is a DocVerify VeriVaulted protected version of the document named above. It was created by a notary or on the behalf of a notary,and it is also a DocVerify E-Sign document,which means this document was created for the purposes of Electronic Signatures and/or Electronic Notary.Tampered or altered documents can be easily verified and validated with the DocVerify veriCheck system. Go to www.docverify.com at any time to verify or validate the authenticity and integrity of this or any other DocVerify VeriVaulted document. • E-Signature Summary E-Signature 1:Jeffrey Bercow(JB) May 22,2020 06:47:53-8:00[CF649E6F9467][38.86.132.2511 jbercow@brzoninglaw.com(Principal) rE-Signature Notary:Diana Ramos(dra)May 22,2020 06:47:53-8:00[34BF7AF6FAFA][38.86.132.251] 11,11dramos@brzoninglaw.com rI,Diana Ramos,did witness the participants named above electronically rsign this document. 1111111111111111111111111111111111111111111111111111111111111111111111 111111111111111111111111111111111111111111111111111111111111111 I I 11111 IcVerify documents cannot be altered or tampered with in any way once they are protected by the DocVerify VeriVault System.Best viewed with Adobe Reader or Adobe Acrobat. visible electronic signatures contained in this document are symbolic representations of the persons signature,and not intended to be an accurate depiction of the persons actual signatui defined by various Acts and/or Laws. Miscellaneous Cash.Receipt CITY OF MIAMI BEACH , ,,. No 426652 Cash 0 Credit Card Rd4etvedof ' " C. �-4 A�� ous-4s" ffr! r<; „ r! 8 t ,�. s^ #. ` , ,, „004499-.uuu4 Mara x ubt111zf�2U o8�F8R7vi ,;� d F©A R OPEtAvidRl- “-- s C 3 } y i t 1 Payment ount: 1,550 00 ..: °.r” 42C0C2 g , (THIS,iNFORMATION!MUST BE COMPLETED}� Of ice.of Finance Director • By eAccount Number ':$ 4 C ! 10 1 t { Prepares: a . . 1°r t. r Dept: EXT •