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Matthew Amster/Carlo Gambino (2)m MIAMBEACH 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) (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) 377-6236 (305) 377-6222 mamster@brzoninglaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. 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) 467-1677 (305) 576-5787 carloC~getcarson.com TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if prindpal is a Corporation, Partnership or Trust [Section 2-482 (c)] • 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: Code Amendment for golf course use exceptions. 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 Ci Commissioners None Jorge Gonzalez, City Manager and Staff None Jorge Gomez, Director of Planning and Staff None IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, PLAT 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 pending bid for goods eguipment or services or on a present or pending award for goods eguioment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": oyes X No• Are you lobbying on a pending application for a Development Agreement with the City or application for chance of zoning map designation or change to the City's Future Land Use Ma°? 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 special 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 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. ... i SignatLhg of Lobbyist 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 contained in Sect~on 2-482 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: re of Principal/Client: '~ a°o LOBBYIST IDENTIFICATION: o n LL ~ a0 O o o Produced ID sis ~~ s N Form of Identification a ~'.~ ~o e~ ~ ~ ~ ~ Personally known (Lobbyist) Z fn ~ K I. SIGNATURE AND STAMP OF NOTARY: fir, County~f Miami-Dade c~WL-~ ~R~ S -~~ PRINCIPAL IDENTIFICATION: - Produced ID Form of Identification .l Personally known (Principal) •'r'MYt,,'•s WIWAMCARSON ie • ~-. ~: :,. MY COMMISSION Y DD 589558 ~•. ~= EXPIRES: October 10, 2010 %~iJf~$~~ Bonded Thru Notary Public Underwriters State of Florida, County of Miami-Da •Sworn and subscrib d before me This day qif ~~IGr~.~/k007 Signature of Public Notary -State of Florida Notarization of Principal's signature FOR CLERKZ'~.l~Sr~ONLY~r,1 Annual Registration fee: [ ]Yes [ ] No Amou aid ~~ , (( VV~ MC ``77 Date Paid Lobbyist Registration Form received and verified by: Entered By: F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc Revised 12/08/04 ~atui=e of Public Notary = ~ Notarization of Lobbyist's