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Matthew Amster/Seth Gadinskym MIAMIBEACH City of Miami Beach Clffice 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, derision 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 S. Biscayne Blvd., Suite 850 Miami Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 377-6236 (305) 377-6222 mamsterCa~brzoninglaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: LOBBYIST RETAINED BY: Seth Gadinsky NAME OF PRINCIPAL/CLIENT: 1680 Michigan Avenue Suite 1001 Miami Beach Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (786) 276-2387 (305) 675-7759 SethCa>Gadinskyrealestate.com TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) out this section if principal is a Corporation, Partnership or Trust [Section 2-482 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: Conditional Use Approval for Walgreens Store at 1011-15 Alton Road Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship Jorge Gomez None Mercy Lamazares None Richard Lorber None IVa DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTNERr A) LOBBYIST DISCLOSURE: (Required) $ 185.00 aer hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 185.00 per hour The folbwing 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 cendirrg 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 change of zoning map designation or chance to the C'itv's Future Land Use Mau? 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 Vou representing snot-for-urofit corporation or entity without scecial compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYLST 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 facts are true and correct and that I have read or am familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting requirements. ,, _ Signature of Lobbyist: `~ ~ i nature of Principal/Client: 4 ~ LOBBYIST IDENTIFICATION: ~ ° ~a ~, .~ ~ ^ Produced ID a $ ~ , Form of Identification a s .E ~~ ~ Personally known (Lobbyist) z ~w I. SIGNATURE AND STAMP OF NOTARY: 3~•`?~ ate of to ida, County f iami-Dade ~'~,,~ or bscribe is day ~ i ature of blic Notary - Sta of Florida Notarization of Lobbyist's signature PRINCIPAL IDENTIFICATION: ^ Produced ID / Form of Identification ~1 Personally known (Principal) State of Florida, County of Miami-Dade Sworn and subscribed before me This day of 20- ~, ~ Marc Haipem r ~, ~ MY Commission DD301094 Signature of Public tary -State of F xpires f-vlarch 29, 2008 Notarization of Principal's signature FOR CL~ER,hK~~'S~ ~US,Ep ONLY Annual Registration fee: [ )Yes [ ] No Amount Pai~ MCR Date Paid