Jeffrey Bercow/Ocean Blvd IICity of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Bach, FL 33139
Email: cityclerk{~ci.miami-beach.fl, us
LOBBYIST REGISTRATION FORM
(City of Miami Beach, City Code Chapter 2, Division 3, Section 2-481)
[] ~ Check Box if an Amendment
Bercow, Jeffrey
NAME OF LOBBYIST: (Last) (First)
200 S. Biscayne Boulevard, Suite 850, Miami, FL 33131
BUSINESS ADDRESS: (Number and Street) (City)
1305) 377-6220
TELEPHONE NUMBER:
(305) 377-6222
FAX NUMBER:
1/2004
(MI.) DATE QUALIFIED AS LOBBYIS I
(State) (Zip Code)
jbercow~..brzoninolaw.com
EMAIL:
I. LOBBYIST RETAINED BY:
Ocean Blvd. II, LLC
NAME OF PRINCIPAL/CLIENT:
328 S. Walnut, Suite 2, Bloominqton, IN 47401
BUSINESS ADDRESS: (Number and Street) (City)
(317) 843-1649 (317) 843-1667
TELEPHONE NUMBER: FAX NUMBER: (Optional)
(State) (Zip Code)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership, or Trust [Section 2-482 (c)]
? NAME OF CHIEF OFFICER, PARTNER OF BENEFICIARY:
Mark A. Siffin
? LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP iNTEREST
IN SUCH CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Transfer of 10th Street Garaqe Lease
Issue to be lobbied (Describe in detail):
II1. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Relationship
~ity Staff None
~layor ~lone
City Commissioners None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATRION (DISCLOSE WHETHER
HOURLY, FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: $420/hourl¥ basis
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIEST COMPENSATION): $420/hourly basis
1)
Pursuant to Ordinance No. 2003-3393 Amendinq Miami Beach City Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Campaiqn Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Campaiqn Contributions By Lobbyists On Procurement Issues":
Are you Iobbyinq on a oresent or oendina bid for aoods, equipment or services, or on a oresent or
pendin~l award for qoods, equipment or service? Yes I~
2)
Pursuant to Ordinance NO. 2003-339S Amending Miami Beach City Code Chaoter 2. Article VII. Division 5
thereof Entitled "Campaiqn Finance Reform" Via The Addition Of Code Section 2-490 Entitled "Prohibited
Campaiqn Contributions By Lobbyists On Real Estate Development Issues':
Are you Iobbyinq on a pendinq application for a Development A;Ireement with the City or al=l)itcation for
chanqe of zoninFI map desif:lnation or chanqe to the City's Future Land Use Mao? Yes
V. SIGNATURE UNDER OATH:
ON OCTOBER 1s'r OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES IN THE CITY OF MIAMI BEACH FOR THE
PRESEDING CALENDAR YEAR.
I do solemnly swear that all of the foreg~ac~;
with the provisions contained in Sectip/n 2-4~82/'qf,tl'
requirements. ~' ~,///
Signature of Lobbyist: ~ ///
Signature of Principal/Client: Y / L___
~,rue an(;I,,~,~rect and that I or am familiar
h~ead
. M ia~9/~C/~a men de d, and all reporting
VI. LOBBYIST IDENTIFICATION:
[] ~ ProducedlD
Form of Identification
j~ ~ Personally Known
VII. SIGNATURE AND STAMP OF NOTARY OR DEPUTY CLERK:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me _
This r~ day of ~'~F/,4d,r~'00~..
~"~"'%' MYCOMMISSION~DD2~7~ I!
] ~ ~ ~*~ EXPIRES: July 20, 2~7
Signature of Public N~tary - State of Florida
Print, stamp or type name of Notary Public
FOR CLERK'S USE ONLY
Registration: A~CCEPTED []REJECTED DATE: ~-.-' ~-~ ~
If rejected, state reason:
Registration fee paid: ~]"~es [ ] No
[ ] Cash [ ] C~e~ MCR