Jeffrey Bercow/Brad Meltzermrs~',AMIBEACH
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, 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 Ordinance 2004-3435.
Bercow Jeffrey
NAME OF LOBBYIST: (Last) (First) (M.I)
Bercow, Radell & Fernandez P.A. 200 South Biscayne Blvd., suite 850 Miami, Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 377-6220 (305) 377-6222 jbercow@brzoninglaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Brad Meltrer
NAME OF PRINCIPAL/CLIENT:
50 North Hibiscus Drive Miami Beach Florida 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786) 693-8701 (786) 693-8751 bmeltrer@km-pleza.com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Par6nership or Trust
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Variance Requests from the Board of Adjustment
Issue to be lobbied (Describe in detail): . .
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual~itie ~ B) Arty Financial, Familial or Professional Relationship
BOA, DRB
None
• IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY
F•LL4I T RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required) $ 490 00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 490.00 per hour
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^ Yes X No Are you lobbying on a present or cending bid for goods equipment or senrices or on a
present or cending award for goods equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled'~Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes X No• Are you lobbying on a cending application for a Development Agreement with the City or
application for chance of zoning man designation or change to the Ciiv's Future Land Use
Mao?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of anot-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 clerk as required by this
section but, shall not be required to pay any registration fees..
^ Yes X No• Are you representing coot-for-profit corporation or entity without saecial compensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPEND S, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE P D G CALENDA R. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPE /~R COM TION DURING THE
REPORTING PERIOD. /
Signat re of Lobbyist
I do solemnly swear that all of foregoi f e true and ect and that I have read or am
familiar with the provisions c tai ed ' S chi f the mi Beach Ci a and all reporting
requirements. /
Signature of Lobbyist: ~~
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LOBBYIST II
Produced ID
Form of Identification
Personally known (Lobbyist)
SIGNATURE AND STAMP OF NOTARY:
County
>'151ic Notary -State of(Fjlor
of Lobbyist's signature
Produced ID
Form of
Personally known
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State of Florida, County of Miami-Dade
Sworn and subscribed before me -?
This ~'~day of 3'u n ~- , 20 41
Signature of Public Nota~ State of Florida
~q Notarization of Prinu 1's signature
FOR CLERK'S U E NLY
Annual Registration fee: ]Yes [ ] No Am aid MCR # Date Paid
Lobbyist Registration Form received and verified Entered By
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBtt57 FORM OS.da Revised 12/08/04