Michael A. Gil/Collins Corner, LLCm 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 Ordnance 2004-3435.
Gil Michael A
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) 377-8690 (305) 377-6222 mgil@brzoninglaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Collins Corner LLC
NAME OF PRINCIPAL/CLIENT:
381 Park Avenue South Suite 1420 New York NY 10016
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(212) 684-7079 ext 19
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Eric Margules
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Redevelopment of 1201, 1221, and 1225 Collins Avenue
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
Planning Dept., HPB, BOA, Planning Board, City Commission None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required) $ 165 00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 165.00 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 lobbvina on a present or cending bid for goods eauioment or services or on a
present or Wending award for goods, eauioment 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 lobbvina on a pending au~lication for a Develoument Agreement with the City or
aaalication for chance of zoning man designation or chance to the Citv'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 snot-for-urofit coruoration 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.
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:
Signature of Principal/C
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
o ~ Form of Identification
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~ ~ , ~ Personally known (Lobbyist)
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~ ~ ~ a VII. SIGNATURE A STAMP OF NOTARY:
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3RjaatGre of Public Notary - Staff of Florida
Notarization of Lobbyists signature
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
'c~ersonally known (Principal)
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Sworn and subscribed before me
This 1~ ~ day of 6 j c fs~'S~; 20 ~
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Signature of Pu ~E Notary -State of-Werida
Notarizationof Principal's signature
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Annual Registration fee: ['~ ]Yes [ ] No Amount Paid - ~ ' ~ a` MCR #~9~~ /~ Date Paid f~ ~" ~' U ~
Lobbyist Registration Form received and verified by: ~• ~ Entered By:
F:\CLER\$ALL\MARIA-M\Lobbylst\LOBBYIST fORM OS.doc Revised 12/08/04