Maefield Holdings, LLC
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a prindpal who seeks to encourage the
passage, defeat or modification of any ordinance, resolution, action or decision of any commissioner; any action, dedsian,
recommendation of the City Manager or any city board or committee; or any action, decision or recommendation of any
city personnel defined in any manner in this section, 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 dty board or
committee. The term specifically indudes the principal as well as any employee engaged in lobbying activities. The term
ftLobbyistsW has specific exclusions. Please refer to Ordinance 2004-3435.
NAME OF LOBBYIST:
Bercow
(Last)
Jeffrev
(First)
(M.I.) DATE QUALIFIED AS LOBBYIST
200 S. Biscavne Boulevard Suite 850
BUSINESS ADDRESS: (Number and Street)
Miami
(City)
Florida
(State)
33131
(Zip Code)
305-374-5300
TELEPHONE NUMBER:
305-377-6222
FAX NUMBER:
EMAIL:
I. LOBBYIST RETAINED BY:
Maefield Holdinos. LLC
NAME OF PRINCIPAUCLlENT:
1526 BlueiavWav
BUSINESS ADDRESS: (Number and Street)
Los Anaeles
(City)
California
(State)
90069
(Zip Code)
310-360-7712
TELEPHONE NUMBER:
310-360-7711
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 OF BENEFICIARY: Mark Siffin
? LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Desian Review Board aDDroval
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of IndlvldualfTltle B) Relationship
Jorae Gomez, Director None
William Carey None
Thomas Moonev None
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $420.00
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $420.00
I Yes' ~~~~s~~: ~t-fo~-o;;fi~:r~n ~r entity without soeclal comoensatlon or
~\ reimbursement. Pursuant to Ordinance No. 2004-3435.
1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach City Code Chaoter 2. Artide VII. Division 5
Thereof Entitled "Camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Procurement Issues":
i Ye,~ No: ~r,: ~~~ ~:b~n: o~ :;:.'::~ o;:n~in~~d:r DODds. eDuloment or services. or on a oresent
or oendlnD award for Doods. eauloment or service?
2)
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL
STATEMENT UNDER OATH, LISTING LOBBYING EXPEN U
IN THE crrv OF MIAMI BEACH FOR THE PRECEDING LE
EVEN IF THERE HAVE BEEN NO EXPENDITURES OR MP
Signature of Lobbyist:
Signature of Principal/Client:
VI.
CA N:
~UCed ID //7~~ /)j/t/. (/C-
, Form of Identification
o Produced ID
Form of Identification
~ersonallY known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
o Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This i1H.e.... day of ~200~
Si~t~~ P:~Ii;;~~a
Notarization of Lobbyist's signature
Signature of Public Notary - State of Florid
Notarization of Principal's signature
FOR CLERK'S USE ON~hl?3'!q
Annual Registration fee: [~es [] No Amount Paid $.. MCR # l::JlJ~ Date Paid ,. / J".O/-
Lobbyist Registration Form received and verified by:
Revised 02/10/04 F: CLER\ALL MARIA-M\LOBBYIS1\LOBBYIST FORM 04
1 First Revision - 05-17-02
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
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, dedsion,
recommendation of the Oty Manager or any city board or committee; or any action, decision or recommendation of any
dty personnel defined in any manner in this section, 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 dty 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.
NAME OF LOBBYIST:
Bercaw
(Last)
Jeffrev
(First)
(M.I.) DATE QUALIFIED AS LOBBYIST
200 S. Biscavne Boulevard. Suite 850
BUSINESS ADDRESS: (Number and Street)
Miami
(City)
Florida
(State)
33131
(Zip Code)
305-374-5300
TELEPHONE NUMBER:
305-377-6222
FAX NUMBER:
EMAIL:
I. LOBBYIST RETAINED BY:
Maefield Holdinas. L.L.C.
NAME OF PRINCIPAUCLlENT:
1526 Blueiav Wav
BUSINESS ADDRESS: (Number and Street)
Los Anaeles
(City)
California
(State)
90069
(Zip Code)
310-360-7712
TELEPHONE NUMBER:
310-360-7711
FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section If principal Is a Corporation, Partnership, or Trust [Section 2482 (c))
? NAME OF CHIEF OFFICER, PARTNER OF BENEFICIARY: Mark Siffin
? LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Gilbert Fein District
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Indlvldual/Tltle B) Relationship
Jorae Gomez, Director None
William Carey None
Thomas Moonev None
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
A) lOBBYIST DISCLOSURE: (Required) $420.00
B) PRINCIPAL'S DISCLOSURE (OF lOBBYIST COMPENSATION): (Required). $420.00
~~:~~~~':nr::t~~~~: ~ ~:~~:~n':'~~~~':~~::;5~r entity without sDecial comDensation or
1) Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach Citv Code Chaoter 2, Article VII. Division 5
Thereof Entitled "Camoaion Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaion Contributions BY lobbvists On Procurement Issues":
~ v...,..t ~~: ~~ ~~~ ~:=Vl': o:~~::~ or :n:~n~~d ~or Goods. eGulDment or services. or on a Dresent
~ or D!!ndlnG award for Goods. eaUIDment or service?
2) Pursuant to Ordinance No. 2003-3395 Amendino Miami Beach Citv Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaion Finance Reform", Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaion Contributions Bv lobbvists On Real Estate Develooment Issues":
iYes1f:~~~a~~Unl~:~;~~~:; :, :~~~~Gr:::~~~~::a=:na :r~~~~::::~~G~:,~e;~::~l~~~ ~: ~aD?
V. SIGNATURE UNDER OATH:
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or
am familiar with the provisions n ined in ction 2-482 of the Miami Beach City Code and all
reporting requirements.
Signature of Lobbyist:
Signature of Principal/CUen :
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
o Produced 10 ~oduced ID
Inti/am ~/tI. {je-
Form of Identification
Form of Identification
~rsonallY known (Lobbyist)
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State of Florida, County of Miami-Dade f r >
S~orn ~UbSCri~ bef:V~e . / ,I If 'i
ThiS -?,t-day of 20.1J~,
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Signature of Public Notary - State of Florid 1 I
Notarization of Principal's signature ,
.. 1 . 1L..i'
FOR CLERK'S USE ON~Cf3~9
Annual Registration fee: [~ [ ] No Amount Paid i. MCR # /~~ Date Paid c.0 If. Cf/-
lobbyist Registration Form received and verified by:
Revised 02/10/04 F: ClER
o Personally known (Principal)
VII.
SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn tp a~ subscribed before me
Th;' l'iii"-doyor~
~~" /
Signature of Public Notary - S te 0 Florid
Notarization of Lobbyist's signature
1 First Revision - 05.17-02
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
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 dedsion 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 defined in any manner in this section, 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.
NAME OF LOBBYIST:
Bercow
(Last)
Jeffrev
(First)
(M.I.) DATE QUALIFIED AS LOBBYIST
200 S. Biscavne Boulevard. Suite 850
BUSINESS ADDRESS: (Number and Street)
Miami
(City)
Florida
(State)
33131
(Zip Code)
305-374-5300
TELEPHONE NUMBER:
305-377-6222
FAX NUMBER:
EMAIL:
I. LOBBYIST RETAINED BY:
Maefield Holdinos. L.L.C.
NAME OF PRINCIPAUCLlENT:
1526 BlueiavWav
BUSINESS ADDRESS: (Number and Street)
Los Anoeles
(City)
California
(State)
90069
(Zip Code)
310-360-7712
TELEPHONE NUMBER:
310-360-7711
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 OF BENEFICIARY: Mark Siffin
? LIST ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Demolition Ordinance re~ardin~ noncontributin~ structures
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Indlvldualmtle B) Relationship
Jorae Gomez, Director None
Mercv Lamazares None
Richard Lorber None
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, IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSAnON (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $420.00
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $420.00
i!!! Yes ~o: Are YOU reDresentinG a not-fo~-o:~~ cc;r~a::~ ~r entity without sDecial comDensation or
I reimbursement. Pursuant to Ordinance No. 2004-3435.
1) Pursuant to Ordinance No. 2003-3393 Amendino Miami Beach Oty Code Chaoter 2. Artide VII. Division S
Thereof Entitled "Camoaion Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaion Contributions BY Lobbvists On Procurement Issues":
i Yes ~o: Are YOU lobbylno on a Dresent or Dendlno bid for Goods. eoulDment or services. or on a Dresent
or Dendlno award for DODds. eouiDment or service?
2) Pursuant to Ordinance No. 2003-3395 AmendinG Miami Beach City Code Chaoter 2. Article VII Division S
thereof Entitled "CamoaiGn Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
CamoaiGn Contributions BY Lobbvists On Real Estate Develooment Issues":
l!IlYe~No: Are YOU lobbyino on a Dendino aDDllcation for a DeyeloDment Aoreement with the City or
aDDlication for chanoe of zoninG maD desionatlon or chanGe to the Clty's Future Land Use MaD?
V. SIGNATURE UNDER OATH:
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or
am familiar with the provisi 0 ined i ection 2-482 of the Miami Beach City Code and all
reporting requirements.
Signature of Lobbyist:
Signature of Principal/Cn
VI.
nON:
tJR'roduced ID ,M;,.n::1. J)rl/.
Form of Identification
o Produced ID
Form of Identification
~rsonallY known (Lobbyist)
o Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to a!;1d subscribed before me
This 1'6 *- day of ~ 20.!?...'+-
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Signature of Public Notary Stat of FI~a
Notarization of Lobbyist's signature
Signature of Public Notary - State of Florida
Notarization of Principal's signature
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FOR CLERK'S USE ONLY
Annual Registration fee: rtrfes [ ] No Amount paid"~c;:() ~R # ~~ ~:?J() Date Paid r;~J;/oY
Lobbyist Registration Form received and verified by: (.J
Revised 02/10/04 F: CLER\ALL\M -M\LOBBYIST\LOBBYIST FORM 04
1 First Revision - 05-17-02