Matthew Amster/Carlo Gambinom MIAMIBEACH
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.
Amster Matthew
NAME OF LOBBYIST: (Last) (First) (I"i•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) 377-6236 (305) 377-6222 mamster@brzoninglaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
LOBBYIST RETAINED BY:
Carlo Gambino
NAME OF PRINCIPAL/CLIENT:
Carlo Gambino 5600 La Gorce Drive Miami Beach Florida 33140
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 576-5776 (305) 576-5787 Carlo@getcarson.com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership 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:
Board of Adjustment Application for 5600 La Gorce Drive
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title ~ B) Any Financial, Familial or Professional Relationship
Jorge Gomez, Director of Planning and Staff ~ None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required) $185.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $185.00 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 services, 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 pending application for a Development Agreement with the Citv or
application for change of zoning map designation or change to the Citv's Future Land Use
MaD?
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 snot-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 anot-for-profit corporation or entity without scecial comcensation
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 EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD. _ . _
Signature of Lobbyist
I do solemnly swear that all of the foregoing
familiar with the provisions contained in Sectio
requirements.
Signature of Lobbyist:
Signature of Principal/C
g c~ LOBBYIST IDENTIFICATION:
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~ `° ^ Produced ID
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Cn .j ~ N Form of Identification
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a ~ c r
a ~ d> ~ Personally known (Lobbyist)
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z° ~ ~ w I. SIGNATURE A(VD STAMP OF NOTARY:
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~AV.
Public NStary - ~t~'ate of Florida
n of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
~1 Personally known (Principal ,~~~iy'~, WILUAMCARSON
_~, r_ MY COMMISSION # DD 589558
~~ EXPIRES: October t0, 2010
pf ~~, Bonded Thru Notary PW~Nc Underwriters
State of Florida, County of Miami-Dade
Swom and ubscribed befor me
This a~ of ~~, 20~
Signature of Public Notary -State of Florida
Notarization of Principal's signature
FO L SE ONLY ~1
Annual Registration fee: [ ]Yes [ ] No Amo t P i MCR ~~~_Date Paid ~ V
Lobbyist Registration Form received and verified Entered By:
F:\CLER\f ALL\MARIA-M\LObbyls[\LOBBYtST FORM OS.da Revised 12/08/04
facts are true and correct and that I have read or am
n 2-482 of the Miami Beach City Code and all reporting