Jeffrey Bercow 2022 Lobbyist Fee Expenditure Forms Yk.
DocuSign Envelope ID:9683C645-2C12-405D-9D89-061A238F6564
City Of Miami Beach RECEIVED
Lobbyist Fee Expenditure and Compensation Form
City Code Section 2-485 FEB 2 5 2022
CITY OF MIAMI BEACH
OFFICE OF THE CITY CLERK
Expenditure report for period of:1/1/2021 through 12/31/2021
A statement shall be filed even if there have been no expenditures or compensation during the reporting period.
This statement is to be signed,notarized and returned to the City of Miami Beach,City Clerks Office,1700 Convention Center Drive,
Miami Beach,FL 33139 by February 28th.A fine of$50.00 per day,per issue,shall be assessed for statements filed after the due
date.If you require any assistance,please contact this office at 305.673.7411 or atcityclerk(a)miamibeachfl.gov.
Lobbyist Jeffrey Bercow
Principal 411 Michigan SOFT Owner, LLC(Alessandro Pallaoro)
Issue Code amendment,development approvals,and planning issues;411-419 Michigan Ave and 944 5th Street
PLEASE COMPLETE THE SECTION BELOW
Detail Compensation Received: 0 0 0
CATEGORIES OF EXPENDITURES
Food and Beverage: (tot
Entertainment: YIOVtL_
Research: ✓UbV1t. ___
Communications: V.ict'L
Media Advertising: NOW,
Publications: W61/1.6
Travel: 1lJ D h P
Lodging: {'l)OVl(i
Special Events: ft)0 N L
CHECK BOX IF YOU NO LONGER REPRESENT THE PRINCIPAL FOR THE ABOVE ISSUE
DATE REPRESENTATION ENDED:
g OATH
State of Florida
County of Miami-Dade
I,the undersigned lobbyist,do hereby depose under oath and affirm that the information disclosed herd 1c A attachment
hereto are true and correct.
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Lobbyist Signature
SIGNATURE AND STAMP OF NOTARY:
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Produced ID
Form of Idenuncauoo Signature of Public Notary-State of Florida
LLSworn to and subscribed before me
Personally known This day of ,20
m 1 Diana Ramos
1 Commission#GG 308355 02/24/2022
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m 1 Notary Public-State of Florida
1 My Commission Expires Apr 10,2023
' DocVerify ID: 'III �*�g'I
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DocuSign Envelope ID:9683C645-2C12-405D-9D89-061A238F6564
City Of Miami Beach
Lobbyist Fee Expenditure and Compensation Form
City Code Section 2-485
Expenditure report for period of:1L1/2021 through 12/31/2021
A statement shall be filed even if there have been no expenditures or compensation during the reporting period.
This statement is to be signed, notarized and returned to the City of Miami Beach,City Clerks Office,1700 Convention Center Drive,
Miami Beach,FL 33139 by February 28th.A fine of$50.00 per day,per issue,shall be assessed for statements filed after the due
date. If you require any assistance,please contact this office at 305.673.7411 or at cityclerk@miamibeachfl.gov.
Lobbyist Jeffrey Bercow
Principal 5800 North Bay Road LLC(Kyle Klopfer)
Issue Development approvals&planning issues;5800 North Bay Road
PLEASE COMPLETE THE SECTION BELOW
Detail Compensation Received: 0'0 0
CATEGORIES OF EXPENDITURES
Food and Beverage: WOW.
Entertainment: VJOttt,
Research: N4
Communications: {NIQlnk.
Media Advertising: h)Ott
Publications: YV OVIC
Travel: NOI412-
Lodging: NOVIZ
Special Events: ylJO t.e
CHECK BOX IF YOU NO LONGER REPRESENT THE PRINCIPAL FOR THE ABOVE ISSUE
DATE REPRESENTATION ENDED:
o OATH
• State of Florida
• County of Miami-Dade
I,the undersigned lobbyist,do hereby depose under oath and affirm that the information disclosed her mAggy attachment
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hereto are true and correct.
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Lobbyist Signature
• SIGNATURE AND STAMP OF NOTARY:
a Produced ID
co Form of Itlentifcau¢
Signature of Public Notary-State of Florida
Sworn to and subscribed before me
Personally known w This day o1 20
Diana Ramos
/ Commission#GG 308355 02/24/2022
/ Notary Public-State of Florida
a / My Commission Expires Apr 10,2023
DocVerify ID:DA485E33-59B1-4F66-BBCA-6825408AF8B6 Pape of 7 2Be254°8AFeae ,III pr9� II III I
www.docvenfy.corn
DocuSign Envelope ID:9683C645-2C 12-405D-9D89-061 A238F6564
City Of Miami Beach
Lobbyist Fee Expenditure and Compensation Form
City Code Section 2-485
Expenditure report for period of:1/1/2021 through 12/31/2021
A statement shall be filed even if there have been no expenditures or compensation during the reporting period.
This statement is to be signed,notarized and returned to the City of Miami Beach,City ClerKs Office,1700 Convention Center Drive,
Miami Beach,FL 33139 by February 28th.A fine of$50.00 per day,per issue,shall be assessed for statements filed after the due
date.If you require any assistance,please contact this office at 305.673.7411 or atcityclerkPmiamibeachfl.Rov.
Lobbyist Jeffrey Bercow
Principal David Alexander Bloch Irrevocable Trust(Marie-France Bloch)
Issue Development approvals&planning issues;420 W 51 St
PLEASE COMPLETE THE SECTION BELOW
Detail Compensation Received: 0 00
CATEGORIES OF EXPENDITURES
Food and Beverage: yVO►1.
Entertainment: W
Research: V1.(,
Communications: •
IVOvtL
Media Advertising: 1'VOVtL
Publications: t4UO
Travel: {Af QvtG
Lodging: L/U014.G _
Special Events: /A)OvtL-
CHECK BOX IF YOU NO LONGER REPRESENT THE PRINCIPAL FOR THE ABOVE ISSUE
DATE REPRESENTATION ENDED:
g OATH
State of Florida
County of Miami-Dade
I,the undersigned lobbyist,do hereby depose under oath and affirm that the information disclosed hey%tty attachment
hereto are true and correct.
Lobbyist Signature
a SIGNATURE AND STAMP OF NOTARY:
Produced ID
Fore o!IdeiUfcd�i cis.
Signature of Public Notary-State of Florida
LL Sworn to and subscribed before me
✓Personally known Diana Ramos This day of ,20
m Commission#GG 308355
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N My Commission Expires Apr 10,2023
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DocuSign Envelope ID:9683C645-2C 12-405D-9D89-061 A238F6564
City Of Miami Beach
Lobbyist Fee Expenditure and Compensation Form
City Code Section 2-485
Expenditure report for period of:1/1/2021 through 12/31/2021
A statement shall be filed even if there have been no expenditures or compensation during the reporting period.
This statement is to be signed,notarized and returned to the City of Miami Beach,City Clerlls Office,1700 Convention Center Drive,
Miami Beach,FL 33139 by February 28th.A fine of$50.00 per day,per issue,shall be assessed for statements filed after the due
date.If you require any assistance,please contact this office at 305.673.7411 or atcityclerk@ymiamibeachfl.gov.
Lobbyist Jeffrey Bercow
Principal David Martin(Terra Group)
Issue Development approvals and permitting issues relating to the property located at 7925-8700 Collins Avenue and
226 87 Terrace, Miami Beach,FL
PLEASE COMPLETE THE SECTION BELOW
Detail Compensation Received: 0.00
CATEGORIES OF EXPENDITURES
Food and Beverage: WO vlit_
Entertainment: L
Research:
Communications: IVO vi C-
Media Advertising: V%J phL
Publications: NOM(r
Travel: Iti0 h L
Lodging: of Ovl L
Special Events: *00414i
CHECK BOX IF YOU NO LONGER REPRESENT THE PRINCIPAL FOR THE ABOVE ISSUE
DATE REPRESENTATION ENDED:
$ OATH
State of Florida
County of Miami-Dade
I,the undersigned lobbyist,do hereby depose under oath and affirm that the information disclose cs&Ad4 Any attachment
hereto are true and correct.
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a SIGNATURE AND STAMP OF NOTARY:
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Form of Identification
Signature of Public Notary-State of Florida
% Sworn to and subscribed before me
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✓Personally known I Diana Ramos ( This day of ,20
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Commission#GG 308355 02/24/2022
Notary Public-State of Florida
My Commission Expires Apr 10,2023
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DocuSign Envelope ID:9683C645-2C12-405D-9D89-061A238F6564
City Of Miami Beach
Lobbyist Fee Expenditure and Compensation Form
City Code Section 2-485
Expenditure report for period of:111/2021 through 12/31/2021
A statement shall be filed even if there have been no expenditures or compensation during the reporting period.
This statement is to be signed,notarized and returned to the City of Miami Beach,City Clerk's Office,1700 Convention Center Drive,
Miami Beach,FL 33139 by February 28th.A fine of$50.00 per day,per issue,shall be assessed for statements filed after the due
date. If you require any assistance,please contact this office at 305.673.7411 or atcitvclerk@lmiamibeachfl.Rov.
Lobbyist Jeffrey Bercow
Principal David Martin/Terra Group.
Issue 8701 Collins Ave.
PLEASE COMPLETE THE SECTION BELOW
Detail Compensation Received: 0'00
CATEGORIES OF EXPENDITURES
Food and Beverage: Wo►,
Entertainment: K/bVIG
Research: Y\JOW_
Communications: I,,,&^^J'O
Iva
Media Advertising: �1t
Publications: AiOVIL
Travel: ik.J 6 V►
Lodging: i/V byl .
Special Events: AJO st,
CHECK BOX IF YOU NO LONGER REPRESENT THE PRINCIPAL FOR THE ABOVE ISSUE
DATE REPRESENTATION ENDED:
OATH
• State of Florida
County of Miami-Dade
I,the undersigned lobbyist,do hereby depose under oath and affirm that the information disclosed ag Ia 0,,py attachment
a hereto are true and correct.
ra2eotCeA.43t-B,457
Lobbyist Signature
• SIGNATURE AND STAMP OF NOTARY:
o '
Q _ Produced ID
co Form of Identification
Signature of Public Notary--State of Florida
LL Sworn to and subscribed before me
" Personally known I Diana Ramos This day of zo
1 Commission#GG 308355 02/24/2022
w 1 Notary Public-State of Florida
a My Commission Expires Apr 10,2023
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DocVerify ID:DA485E33-59B1-4F66-88CA-B825408AF8B6 Page 5 of 7 5B825408AF8B6 ,III It ,I II
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DocuSign Envelope ID:9683C645-2C 12-405D-9D89-061 A238F6564
City Of Miami Beach
Lobbyist Fee Expenditure and Compensation Form
City Code Section 2-485
Expenditure report for period of:1/1/2021 through 12/31/2021
A statement shall be filed even if there have been no expenditures or compensation during the reporting period.
This statement is to be signed,notarized and returned to the City of Miami Beach,City Clerk's Office, 1700 Convention Center Drive,
Miami Beach,FL 33139 by February 28th.A fine of$50.00 per day,per issue,shall be assessed for statements filed after the due
date. If you require any assistance, please contact this office at 305.673.7411 or atcityclerk@miamibeachfl.gov.
Lobbyist Jeffrey Bercow
Principal Fontainebleau Miami Beach Hotel
Issue Fontainebleau Hotel
PLEASE COMPLETE THE SECTION BELOW
Detail Compensation Received: 0' 00
CATEGORIES OF EXPENDITURES
Food and Beverage: f.'"'t-
Entertainment: ►'✓D►'l(r
Research: NOV-
Communications: VJ OVIL
Media Advertising: /U OK
Publications: NUOvt_,-
Travel: 1)Ovt(-
Lodging:
Special Events: yV 0✓lG
CHECK BOX IF YOU NO LONGER REPRESENT THE PRINCIPAL FOR THE ABOVE ISSUE
DATE REPRESENTATION ENDED:
OATH
• State of Florida
County of Miami-Dade
• I,the undersigned lobbyist,do hereby depose under oath and affirm that the information disclosedlywattachment
• hereto are true and correct.
e 2cocoAaero3.,
CO Lobbyist Signature
• SIGNATURE AND STAMP OF NOTARY:
Produced ID
m Fo m of dennriwtw" Signature of Public Notary—State of Florida
LL Sworn to and subscribed before me
• _Personally known / Diana Ramos This day of ,20
1 Commission#GG 308355
w 1 Notary Public-State of Florida 02/24/2022
a 1 My Commission Expires Apr 10,2023
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DocuSign Envelope ID 9683C645-2C12-405D-9D89-061A238F6564
City Of Miami Beach
Lobbyist Fee Expenditure and Compensation Form
City Code Section 2-485
Expenditure report for period of:11/2021 through 12/31/2021
A statement shall be filed even if there have been no expenditures or compensation during the reporting period.
This statement is to be signed,notarized and returned to the City of Miami Beach,City Clerk's Office, 1700 Convention Center Drive,
Miami Beach,FL 33139 by February 28th.A fine of$50.00 per day,per issue,shall be assessed for statements filed after the due
date. If you require any assistance,please contact this office at 305.673.7411 or atcityclerk@miamibeachfl.gov.
Lobbyist Jeffrey Bercow
Principal Gumenick Family Investments No.2(Randy Gumenick)
Issue Development approvals and planning issues;959 West Ave
PLEASE COMPLETE THE SECTION BELOW
Detail Compensation Received: 0.00
CATEGORIES OF EXPENDITURES
Food and Beverage: ► OWO
Entertainment: _ hjQ►/w
Research: MM.?,
Communications: h1 Qv1 G
Media Advertising: Yf Qv1L
Publications: hJ O—
Travel: YO MV1 t
Lodging: �pv1G
Special Events:
CHECK BOX IF YOU NO LONGER REPRESENT THE PRINCIPAL FOR THE ABOVE ISSUE
DATE REPRESENTATION ENDED:
$ OATH
State of Florida
County of Miami-Dade
a I,the undersigned lobbyist,do hereby depose under oath and affirm that the information disclosed he6 9sAvy attachment
a hereto are true and correct.
0
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Lobbyist Signature
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SIGNATURE AND STAMP OF NOTARY:
Produced ID
form of de-tl'Icat.r,
Signature of Public Notary—State of Florida
Sworn to and subscribed before me
Personally known Diana Ramos This day of ,20
Commission#GG 308355
Notary Public-State of Florida
My Commission Expires Apr 10,2023 02/24/2022
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D'ocuSign Envelope ID:9683C645-2C12-405D-9D89-061A238F6564
City Of Miami Beach
Lobbyist Fee Expenditure and Compensation Form
City Code Section 2-485
Expenditure report for period of:1/1/2021 through 12/31/2021
A statement shall be filed even if there have been no expenditures or compensation during the reporting period.
This statement is to be signed,notarized and returned to the City of Miami Beach,City Clerk's Office,1700 Convention Center Drive,
Miami Beach,FL 33139 by February 28th.A fine of$50.00 per day,per issue,shall be assessed for statements filed after the due
date. If you require any assistance,please contact this office at 305.673.7411 or atcityclerk@miamibeachfl.Kov.
Lobbyist Jeffrey Bercow
Principal Lincoln Center Associates,LLC(Melvyn Schlesser)
Issue Development approvals and permitting issues;670 Lincoln Road
PLEASE COMPLETE THE SECTION BELOW
Detail Compensation Received: 0'00
CATEGORIES OF EXPENDITURES
Food and Beverage: UJ O►
Entertainment:
Research: ►/v O✓1 L
Communications: V%J v1 t,
Media Advertising: A/JO 4(�
Publications: LA/O 1/1 fi
Travel: I/U611 �-
Lodging: WOO e
Special Events: I&J 1(/
CHECK BOX IF YOU NO LONGER REPRESENT THE PRINCIPAL FOR THE ABOVE ISSUE
DATE REPRESENTATION ENDED:
0 OATH
• State of Florida
• County of Miami-Dade
I,the undersigned lobbyist,do hereby depose under oath and affirm that the information disclosedclatrgamAlAgy attachment
N hereto are true and correct.
0
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o Lobbyist Signature
O SIGNATURE AND STAMP OF NOTARY:
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Produced ID
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Signature of Public Notary-State of Florida
Diana Ramos Sworn to and subscribed before me
V Personally known Commission#GG 308355 This day of ,20
Notary Public-State of Florida
My Commission Expires Apr 10,2023 02/24/2022
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DocuSign Envelope ID:9683C645-2C12-405D-9D89-061A238F6564
City Of Miami Beach
Lobbyist Fee Expenditure and Compensation Form
City Code Section 2-485
Expenditure report for period of:1/1/2021 through 12/31/2021
A statement shall be filed even if there have been no expenditures or compensation during the reporting period.
This statement is to be signed,notarized and returned to the City of Miami Beach,City Clerk's Office,1700 Convention Center Drive,
Miami Beach,FL 33139 by February 28th.A fine of$50.00 per day,per issue,shall be assessed for statements filed after the due
date. If you require any assistance,please contact this office at 305.673.7411 or atcityclerk@miamibeachfl.gov.
Lobbyist Jeffrey Bercow
Principal M-524 Jefferson Owner,LLC(Camilo Miguel)
Issue Legislative lobbying regarding proposed 6th Street Overlay District
PLEASE COMPLETE THE SECTION BELOW
Detail Compensation Received: 0' 00
CATEGORIES OF EXPENDITURES
Food and Beverage: 144111.
Entertainment: INOhc
Research: N)Gn
Communications: yVbb. .
Media Advertising: N16v1t
Publications: KJ OH.L
Travel: ►'1.)0 vie--
Lodging: tAJ 0✓l L
Special Events: ,►NO✓t.G
CHECK BOX IF YOU NO LONGER REPRESENT THE PRINCIPAL FOR THE ABOVE ISSUE
DATE REPRESENTATION ENDED:
OATH
a;
N
0 State of Florida
County of Miami-Dade
I,the undersigned lobbyist,do hereby depose under oath and affirm that the information disclosed herd ugfldnly attachment
hereto are true and correct.
ALUM-LI/VUF CJ45J...
Lobbyist Signature
SIGNATURE AND STAMP OF NOTARY:
CO Produced ID
Form or Idenbf,cafion Signature of Public Notary-State of Florida
Sworn to and subscribed before me
✓_Personally known This day of ,20
csiDiana Ramos
Commission#GG 308355 02/24/2022
LL Notary Public-State of Florida
My Commission Expires Apr 10,2023
. mom ..w.�„
' Doc Verify ID;57277F0C-CD2E-4ED1-A350-69E9869001)30 IIIIESFAM11111
www.docveri.com Page 2 of 7 289E98890DD30
DocuSign Envelope ID:9683C645-2C12-405D-9D89-061A238F6564
City Of Miami Beach
Lobbyist Fee Expenditure and Compensation Form
City Code Section 2-485
Expenditure report for period of:1/1/2021 through 12/31/2021
A statement shall be filed even if there have been no expenditures or compensation during the reporting period.
This statement is to be signed,notarized and returned to the City of Miami Beach,City Clerk's Office, 1700 Convention Center Drive,
Miami Beach,FL 33139 by February 28th.A fine of$50.00 per day,per issue,shall be assessed for statements filed after the due
date.If you require any assistance,please contact this office at 305.673.7411 or atcityclerkPmiamibeachfl.gov.
Lobbyist Jeffrey Bercow
Principal Marina Park, LLC(David Martin)
Issue Lease amendment,extension,and related matters regarding Miami Beach Marina located at 300-344 Alton Road
PLEASE COMPLETE THE SECTION BELOW
Detail Compensation Received: Q •00
CATEGORIES OF EXPENDITURES
Food and Beverage: VVOvtt..-
Entertainment: V1,J�►.t.t.
Research: VVOv►(,
Communications: yV bvt L-
Media Advertising: IN 6vt _
Publications: ►Obvt--
Travel: v\JOK(r
Lodging: V110 G
Special Events: VV0v1 C
CHECK BOX IF YOU NO LONGER REPRESENT THE PRINCIPAL FOR THE ABOVE ISSUE
DATE REPRESENTATION ENDED:
9 OATH
• State of Florida
County of Miami-Dade
I,the undersigned lobbyist,do hereby depose under oath and affirm that the information disclose e gA ivy attachment
• hereto are true and correct.
o ` A fsco,woro3r,
o Lobbyist Signature
SIGNATURE AND STAMP OF NOTARY:
m
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m
Produced ID
a Form of Identification Signature of Public Notary—State of Florida
Sworn to and subscribed before me
Personally known /Diana Ramos This day of ,20___
1 Commission#GG 308355 02/24/2022
LL 1 Notary Public-State of Florida
N My Commission Expires Apr 10,2023
•
' DocVerify ID:57277F0C-CD2E-4E01-A350-B9E98B90DD30 Page 3 of 7 3B9E98B90DD30 ,III ��-444;, ,I II
www.docverify.com
DocuSign Envelope ID:9683C645-2C12-405D-9D89-061A238F6564
City Of Miami Beach
Lobbyist Fee Expenditure and Compensation Form
City Code Section 2-485
Expenditure report for period of:111/2021 through 12/31/2021
A statement shall be filed even if there have been no expenditures or compensation during the reporting period.
This statement is to be signed,notarized and returned to the City of Miami Beach,City Clerls Office, 1700 Convention Center Drive,
Miami Beach,FL 33139 by February 28th.A fine of$50.00 per day,per issue,shall be assessed for statements filed after the due
date. If you require any assistance,please contact this office at 305.673.7411 or atcityclerk@miamibeachfl.gov.
Lobbyist Jeffrey Bercow
Principal Miami Beach Marina Associates, LTD(David Filler)
Issue Lease Amendment and Extension and related matters regarding 300-344 Alton Road in Miami Beach,Florida
PLEASE COMPLETE THE SECTION BELOW
Detail Compensation Received: 0. 00
CATEGORIES OF EXPENDITURES
Food and Beverage: W bK G
Entertainment: 1..)0ltiL
Research: VUOL4e
Communications: ►UOvte
Media Advertising: !v Wit-
Publications: WOOL-
Travel: YUb V C-
Lodging: IV L
Special Events: NOW.
CHECK BOX IF YOU NO LONGER REPRESENT THE PRINCIPAL FOR THE ABOVE ISSUE
DATE REPRESENTATION ENDED:
OATH
• State of Florida
• County of Miami-Dade
• I,the undersigned lobbyist,do hereby depose under oath and affirm that the information disclosed hskglrgibipy attachment
hereto are true and correct.
O
om �A2toi,DxnOFaJco9...
o Lobbyist Signature
SIGNATURE AND STAMP OF NOTARY:
m Produced ID
Form of Identification Signature of Public Notary—State of Florida
Sworn to and subscribed before me
N ti Personally known Diana Ramos This day of ,20
o Commission#GG 308355
LL Notary Public-State of Florida 02/24/2022
My Commission Expires Apr 10,2023
' DDoccVdeorifyeID: 7277F0C-CD2E-4ED1-A350-89E98B90DD30 Page 4 of 7 4B9E98B90DD30 'III PI . ,III I
DocuSign Envelope ID:9683C645-2C12-405D-9D89-061A238F6564
City Of Miami Beach
Lobbyist Fee Expenditure and Compensation Form
City Code Section 2-485
Expenditure report for period of:1/1/2021 through 12/31/2021
A statement shall be filed even if there have been no expenditures or compensation during the reporting period.
This statement is to be signed,notarized and returned to the City of Miami Beach,City Clerk's Office,1700 Convention Center Drive,
Miami Beach, FL 33139 by February 28th.A fine of$50.00 per day,per issue,shall be assessed for statements filed after the due
date. If you require any assistance,please contact this office at 305.673.7411 or atcityclerkPrniarnibeachfl.gov.
Lobbyist Jeffrey Bercow
Principal MT2 Properties, LLC(Dana Treister)
Issue Development approvals&Planning issues; 1554 W 25th Street
PLEASE COMPLETE THE SECTION BELOW
Detail Compensation Received: •0 b
CATEGORIES OF EXPENDITURES
Food and Beverage: Wo�t-
Entertainment: Y'Jt a
Research: wfltAC,
Communications: VUOw t.
Media Advertising: yvow�
Publications: yt)bK`
Travel: A/ti t
Lodging: /'VOn t.
Special Events: IVVOvt
CHECK BOX IF YOU NO LONGER REPRESENT THE PRINCIPAL FOR THE ABOVE ISSUE
DATE REPRESENTATION ENDED:
0. OATH
a State of Florida
• County of Miami-Dade
I,the undersigned lobbyist,do hereby depose under oath and affirm that the information disclosed h-ErcaiiilActIpny attachment
0
• hereto are true and correct.
` A2CCCDA4eFB5455...
Lobbyist Signature
• SIGNATURE AND STAMP OF NOTARY:
m
Produced ID
Form of Identification
Signature of Public Notary-State of Florida
�sonanown k y ll Sworn to and subscribed before me
N -Per Diana Ramos This day of ,20
o Commission#GG 308355
Notary Public-State of Florida 02/24/2022
My Commission Expires Apr 10,2023
IDocVerify ID:57277F0C-CD2E-4ED1-A350-B9E9889012D30
wwwdocverify.com Page 5 of 7 5B9E98890DD30 'III ;,III
•
UocuSign Envelope ID:9683C645-2C12-405D-9D89-061A238F6564
City Of Miami Beach
Lobbyist Fee Expenditure and Compensation Form
City Code Section 2-485
Expenditure report for period of:1/1/2021 through 12/31/2021
A statement shall be filed even if there have been no expenditures or compensation during the reporting period.
This statement is to be signed,notarized and returned to the City of Miami Beach,City Clerk's Office,1700 Convention Center Drive,
Miami Beach,FL 33139 by February 28th.A fine of$50.00 per day,per issue,shall be assessed for statements filed after the due
date. If you require any assistance,please contact this office at 305.673.7411 or atcityclerkPrniamibeachfl.Rov.
Lobbyist Jeffrey Bercow
Principal Southgate Towers,LLLP(Randy Gumenick)
Issue Development approvals and planning issues;910 West Ave
PLEASE COMPLETE THE SECTION BELOW
Detail Compensation Received: 0•DO
CATEGORIES OF EXPENDITURES
Food and Beverage: VUOht
Entertainment: Wpm,
Research: Y11pvt g
Communications: iND I44.-
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CHECK BOX IF YOU NO LONGER REPRESENT THE PRINCIPAL FOR THE ABOVE ISSUE
DATE REPRESENTATION ENDED:
OATH
• State of Florida
• County of Miami-Dade
• I,the undersigned lobbyist,do hereby depose under oath and affirm that the information disclosed herejn a ddaaoyyattachment
hereto are true and correct.
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• SIGNATURE AND STAMP OF NOTARY:
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Form of Identification Signature of Public Notary-State of Florida
Sworn to and subscribed before me
Diana Ramos o !/0- This dayerSOnally known Commission#GG 308355 of 20
Notary Public-State of Florida 02/24/2022
My Commission Expires Apr 10,2023
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GocuSign Envelope ID:9683C645-2C12-405D-9D89-061A238F6564
City Of Miami Beach
Lobbyist Fee Expenditure and Compensation Form
City Code Section 2-485
Expenditure report for period of:1/1/2021 through 12/31/2021
A statement shall be filed even if there have been no expenditures or compensation during the reporting period.
This statement is to be signed,notarized and returned to the City of Miami Beach,City Clerk's Office,1700 Convention Center Drive,
Miami Beach, FL 33139 by February 28th.A fine of$50.00 per day,per issue,shall be assessed for statements filed after the due
date. If you require any assistance,please contact this office at 305.673.7411 or at cityclerk(almiamibeachfl.gov.
Lobbyist Jeffrey Bercow
Principal Terra Group(David Martin)
Issue Miami Beach Convention Center Hotel;1901 Convention Center Drive
PLEASE COMPLETE THE SECTION BELOW
Detail Compensation Received: Q'O b
CATEGORIES OF EXPENDITURES
Food and Beverage: /'VOVie
Entertainment: wOVIC
Research: (/Vp,L
Communications: VUnkt.e_
Media Advertising: `)0n t
Publications: vLp✓1 e-
Travel: /Vau
Lodging: WO✓tt-
Special Events: hf ON&
CHECK BOX IF YOU NO LONGER REPRESENT THE PRINCIPAL FOR THE ABOVE ISSUE
DATE REPRESENTATION ENDED:
OATH
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County of Miami-Dade
• I,the undersigned lobbyist,do hereby depose under oath and affirm that the information disclosedhcgksilpligpy attachment
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My Commission Expires Apr 10,2023
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