2024 Lobbyist Registration Form - 94 Palm Ave (Jamie Mandel) �L/ 1'�� M ��-L -
Dacusign'Envelope 16. 159D2AFA-]BC1-44C5-A90LEWESFCCFICO
RECrIVED
� � , � ��,n I gEACH
on�ceormec��yaerk AUG 302024
1700 Convenlion Center Drive
Miami eeach, F� 33139 L:ITY UF MIAMI BEACFI
305.6737411 pFF!Cc OF THF C!TY GLERR
LOBBYIST REGISTRATION FORM
Lobbyisl means all persons employed or retainetl, whe�her paid or not, by a pnncipal who seeks �o encourage�he passage, defeat or
modifcalion of any oMinance, resolu�ion, ac�ion or tlecision of any commissioner; any action, decision, recommentla[ion of the Ciry
Manager or any Gity board or committae;or any actian,decision or recommentla[ion of any City personnel tluring tl�e time periotl of Ihe
entire decision-making process on such action, tlacision or recommendation �hat foreseeably will be heaM or reviewed by ihe Cily
commissioq or a City board or committee. The term specifically indutles the principal as well as any emplayee engaged in lobbying
activities.Tha term"Labbyisis"has specific exclusions. Pleasa refer to City Code Chapter 2, Micle VII, Division 3,entitled"Lobbyists;
for addi�ional information.
Instmclions: Please completa all sections of this(orm antl submi��he completed fortn.wi[h the applicable fee, to�he Office ot Ihe Ci�y
Clerk. If you naed more space �o comple�e an answer, use a separa�e sheeqs) of paper. I(you have no�hing to repoh in a par�icular
sec�ion, you mus[ wri[e "none" or "nla" in �ha� sec�ion. Any change to any information originalty filed, or any atltli�ional Ci�y
Commissioner or personnel who are also soughl�o be lobbietl shall reQuire lha��he lobbyist file an amentlment�o�M1e regis�ra�ion form.
The lobbyist has a con�inuing dury to supply informa[ion and amentl �he forms filed throughom the period �ha� �he lobbying occurs.
Separa�e regisUa�ion forms shall be reQuiretl for each principal raprasentetl on each specific issue.
I. LOBBYIST INFORMATION:
Balter Emily K.
NAME OF LOBBYIST (Les�) (Flrs�) (Mltltlle Name)
Bercow Radell Fernandez Lazkin&Tapanes, PLLC 200 S. Biscayne Blvd.,Suite 300, Miami, FL 33131
LOBBYISTBUSMESSNAMEANOADDRE55 (Num�eran031ree�) (Ci�yJ (S�a�e) (ZlpCoae)
(305)374-5300 ebalter@brzoninglaw.com
LOBBVISTBUSMESSTELEPHONENUMBER CELWLARTELEPHONENUMBER EMAILADDRESS
II. PRINCIPAL INFORMATION:
Mandel 6. Jamie
NAME OF PRINCIPAL (LasI) (Flrst) (Mltltlle Name)
Palm Island Residence Trust 94 Palm Avenue Miami Beach Florida 33139
PRINGIPALBUSINE33NAMEANOA�DRESS (NumberentlS�reaQ (QtyJ (S�ate) (LOCotle)
��R�� F'�5-1066 jbmande118QgmaiLcom
�
PRINGIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPNONE NUMBER EMAIL ADDRESS
� _ Pursuant to Ciry Cutle Sec�ion 2>82�h)(1)(aj: A principal af any wrporation, paMership, or o1M1er entiry who appears as a IOUCyist on �ehatt of tM1at
` enlily,wiNoul special mmpensa�ion or reimbursemenl for t�e appearance,wM1elM1er tlirect, InGlrecq orcon�ingen�,lo express suppotl o(or opposition lo
.. an Item s�all registerwi��fM1e CIeM1 as requiratl by��is suEsection but shall not be ra0ulretl�o pay any regis�rationlees.
� ' If the principal is a Corporetion, Partnership or Trust, the following information MUST be provided
pursuant to City Code 5ection 2-462(c):
- • NAME OF CHIEF OFFIGER,PARTNER,OR BENEPICIARV(iT none,write N/A�: lamie 13.Mandcl ,luthorized Penon
. NAME OF ALL PERSONS XOLDING,DIRECTLV OR INDIRECTLV,A 5%OR MORE OWNERSHIP INTEREST IN SIICH
CORPORATION,PARTNERSNIP OR TRUST(iT none,write NIA): See atlached
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III. ISSUE TO BE LOBBIED:
Describe with as much detail as is proctical, including but not limited to a specific description where
applicable ot a pending request for proposal, invitation to bid, or public haaring number.
Development Approvals &Permitting Issues,including but not]imited to the Historic Preservation
Board, Design Review Board, Planning Board, Board of Adjustment, Land Use Development Citv
Commission, and any City Workshops or Committees, if necessary, relating to the property located
at 94 Palm Avenue in Miami Beach, Florida.
IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2482(a)(4�, list the City Commissioner or City personnel sought to be
lobbied, and whether the lobbyist has entered into any contractual relalionship (paid or unpaid) with
said City Commissioner or City personnel from 12 mon[hs preceding such commencemen[ of service
with the City to the present date, stating the general nature of the subject controctual relationship.
Full Name of Individual and . Contractual Relationship(H yes,explain) YES NO
Title o/Person to be Lobbied '
Staff for the Planning&Building Deparhnent None X
Public Works &Ci AdministraHon, PB, HPB, BO None X
DRB, City Commission, and Mayor as necessary None X
Land Use &Sustainabili Committee None X
Pursuant to City Code Section 2-482�g�, every registrent shall be required to state the extent of any
business, financial, familial or profassional relationship, or other relationship giving rise [o an
appearance of an impropriety, with any current City Commissioner or City personnel who is sought to
be lobbied as identified on the lobbyist registralion form filed.
= List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an
� a earanee of im m rie it none,write N/A :
None
= V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Suecifia (Note that a
. contingency fee is prohibited pursuant to City Code Sec. 2d85.3):
- 3535.00 per hour
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The Tollowing six(6)questions MUST be answeretl:
1) Pursuan��o Ci[y Coda Section 2-488,en�itled"Pmhibi[ed Campaign Con�nbu�ions By Lobbyists On Pmcurement Issues":
Ves xNo: Are vou lobbvinn on a oresent or centlinp bid tor 000ds, eouioment or services. or on a oresent or
pendina award for aoods.eauioment or servicel
2) Pursuant to City Ccde Sec[ion 2-090, entilled"Prohibitetl Campaign Coninbutions By Lobbyisis On Real Eslate Developmen�
Issues":
Ves X No: Are vou lobbvina on a oendina aoolication(or a Develooment Anreement with ihe CiN or aooliea[ion
for chanae of zoninn mao desi0nation o�chanae to Ihe Cilv's FUNre Lantl Uae Mao?
3) Pursuant to Ciry Code Sec�ion 2-482�h), any person (excepl Ihose exampt bom Ihe tlefini[ion o� "IobbyisP' as set fohh in
Setlion 2<81) who only appears as a represen�a[ive of a not-for-pro��corporaYon or enti�y wi�hou�special wmpensa�ion or
reimbursement for the appearance,whether direct or intlirect ta express support of or opposition lo any item.shall regisler wilh
lhe ci�y clerk as required by�his set�ion,but shall no�be requiretl�o pay any regis�ra�ion fees.
VesxNo: Are vou reoresentina a not-tor-orafit corooration or entitv without soecial comoensation or
reimbursemantT
4) Pursuant to Ciy Catle Section 2-087, �he tertn "lobbyis�"speci(cally exdutles Iha following persons: Enpetl wi�nesses who
pmvide onty scian�ific, techniral or other specialized infortnalion or�astimony in public meetings;any person who only appears
as a represenla�ive of a neighbarhood associa�ion wi�houl compensation or reimbursemenl for�he appearance,whe�her tlirec�,
indired or contingant,to express suppotl of or opposition lo any itam;antl any person who only appears as a represenlativa of
not-for�rofil wmmunity based organiza�on for Ihe purpose of reques�ing a grant withom special compensa�ion or
reimbursemen�for the appearance.
YesXNo: Are vou orov'd'nn onlv sc'entfc technical or other soecialized intormation: aooearinn as a
reoresenWt've of a neiohbarhood association without soacial comcensation or reimbursement or
reoreaenl'na a not-torbroT't basetl oraanization for ihe ouroose ot reaues�ina a arenl without
scecial comcensation o�reimbursemen�]
5) Pursuan� lo City Cotle Section 2d97(1). no campaign consultant shall lobby ihe City Commission for a penotl of 12 months
following the sweanng in of any electetl offcial(s)for whom ihe campaign consullant provitletl rampaign consWting services
within Iha pas�election cycle. See Section 2391 (or more information.
Ves XNo: Have vou orov'tletl camoaian consultina senices to an incumbent member of the LiN Commission
within the oast election cvcleT If ves,olease list the incumbent memberlsl of the CiN Commission:
Ves x No: It ves has 't been less than 12 months since the elecletl official(sl whom vou orovidetl camoaian
consultina services was sworn in�
6) Pursuan��o City Code Sedion 2-482�a)�4�a.,a lobbyis�who has wi�hin �he pas�election cycle pmvitletl campaign consulting
services to an incumbent member of the Ci�y Commission (which lob�ying ac�ivity is no[o�herwise pmhibiletl by Cotle section
2-491) shall tlisclose such particular service on his/her lobbyis� regisUa�ion lorm and shall orallv d sdose such oarticular
servi ce�efora lobbvina�he CiN Commission at a oublic mee�inq.
Yes%No: Mave vou orov tletl wmoa an consultina services to an incumbent member of the Citv Commission
. w'th'n ihe oast elecFon cvcle?If ves olease liat the inwmbent membarlsl of ihe Citv Commiasion:
� Ves X No: I( ves were vou orom'sed or did vou receive economic consideration in exchanae (or camoaian
- consultina servicea?
" :�JS / TO BE COMPLETED BY CRY CLERR'S STNFF ONLY 1
" AnnuelRegisintlonfee: [r'Yes[ �No NnountPaiytl�S���b MCRf1�j'����/ Da[ePaIA� 30 't'
Lobbyirt Regiatntian Fa�m raceived antl vetlfletl by:- l��
F\RCR\SALL\aFORMS�LOBBY15iFORMS\Lobbyis[ReglSha�lonFo�mRwlu'� 09-ID9P0.EG.tloc RevisedW/20/2018
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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 LOBBVING EXPENDITl1RE5. AS WELL AS COMPENSATION
RECEIVEO. 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 COM IF�EIObDURING THE REPORTING PERIOD.'
Signature of LobbyisC �'"�'"1 �� Da�e oa;sa,�zoza
I do solemnly swear or aftirm that all of the foregoing tads, slatements, and disclosures in Ihis form are Irue and correcl,
and Ihal I have read or am familiar wilh Ihe provisions conlained in Chapter 2, Art. VII, Division 3, entitled "Lobbyisls" of
the Miami Beach Ciry C FldaM�reporting requirements.
SignaWreofLobbyisC ��� �� �.=w: Date oeizeimz4
.s a��
Signature of Principaf � � �J � Date oena�zo2a
ansv�z�
VII. NOTARY SIGNATURE AND SEAL:
LOBBYIST: PRINCIPAL
State of Florida State of Florida
CountyoE Miami-Dade Counlyof: Miami-Dade
Swom to (or affrmed)and subscri6ed 6efore me, Swom to(or affirmetl)and subscribed before me,
by means of 0 physical presence by means of 0 physical presence
or� online nolarizalion, or O online notarization,
ihis_day of . 20_, by this_day of . 20_, by
Emily K. Balter Jamie B. Mandel
NAME OF LOBBVIST NAME OF PRWCIPAL
ProducedlD _ProducedlD
FORM OF IOENTIFICATION FORM OF IDENTIRCATION
x personally Kno x personall
�. L . ` --_.,. �
SignaWre of No�ary Public SignaWre of Notary Public
Diana Ramos Diana Ramos
Name of Notary, Typed, Printed or Slamped Name of Notary, Typed, Printed or Slamped
� DlanaRamos D�anaRamos
Commission fl HH 38692] Commlasion N HH 38692'/
Notary Public-S�a�e of Flontla No�ary Public-S�a�e af Floritla
' My Commission Expires Apr ifi,202] My Commisson Expi�es Apr 16,202]
- ' The persone:
- Ezpetl wi�nesses wha pmvide only scieNifc,�echnical or o�har specializetl infortnation or�estimony in public meetings;any person who
only appears as a represen�aGve of a neighborhood associalion withom compensalion or reimbursement for�he appearanca,whe�her
direc�,indired or con�inganl,�o express suppotl of or opposi�ion to any ilem;and any perwn who only appears as a represen�a[ive ot
no4for-proft community basetl organiza�ion far�he purpose of reques�ing a grant wi�hoW special wmpensa�ion or reimbursement for
the appearance.
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Ciy of Miami Beaah, I]00 Comemlon Cenrer Dd�e,Mlaml eeoch, Flodda 33139,www.miomibeachA.go�
OBice of ihe Ciry Clerk
Rafael E. Gronoda, Gry Clerk CiryClerk�mlamibeachfLgov
TeL 305.6�37411, Fax�. 305673J254
NAME OF LOBBYIST: Emilv K Balter
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 fled 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 30'" of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fne 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 specifc 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 lobbying on
that issue, I shall immediately fle a Notice of Withdrewal 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 Sec[ion 2-482 of the Miami Beach Cify Code.
- _���i�a�� OB/28/2024
- Signature of Lobbyis'� Date
��.i.us,.i i aroams.oeeris,.okmsim�ws�a�a.Pe��o�ra,m ae.«aa w��zo ers m�
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Disclosure of interest for"Palm Island Residence Trust"
Palm Island Residenca Trus�
TRUSTNAMF
NAME AND ADDRESS e INTEREST
Palm Island Holdinps, LLC as Trustee 0%
257 Little Falls Dnve,Wilmington, DE 19808
Benaficiaries:
David Centner 50%
Leila Cenlner 50%
3921 Atton Road,#465, Miami Beach, FL 33140
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