Michael Gil/304-312 Ocean Drive, LLC~ • 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) (Zlp Code)
(305) 377-8690 (305) 377-6222 mgil@brzoninglaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
304-312 Ocean Drive, LLC
NAME OF PRINCIPAL/CLIENT:
600 North 3rd Street 2nd Floor Philadelphia PA 19123
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(215) 625-9722 (215) 625-0167 IouisiorocofskylCa earthlink.net
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: Phillip McFillin, Louis Orocofsky
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: Phillip McFillin
II. SPECIFIC LOBBY ISSUE:
Redevelopment of 304-312 Ocean Drive - COA, Variance Approvals, and Conditional Use Permit
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title I B) Any Financial, Familial or Professional Relationship
Planning Dept., HPB, BOA, Planning Board, City Commission * None
* Unless an issue is legislative in nature, HPB, BOA, Planning Board, and City Commission members are not lobbied outside of a public hearing setting.
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• } FLAT RATE OR OTHERJ:
A) LOBBYIST DISCLOSURE: (Required) $ 220.00 oer hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 220.00 oer 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 Wresent or Wending bid for goods eauioment or services or on a
Wresent 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 yQu lobbyirsg on a Wending aWWlication for a Development Agreement with the City or
~WWlication for change of zoning man designation or chance to the City'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 you representing anot-for-Wrofit 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.
Signature of Lobbyist
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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/Client:
VI. LOBBYIST IDENTIFICATION: ?~
^ Produced ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
~igtrefure o~ Public Notary - St43Ee of Florida
Notarization of Lobbyist's signature
PAL IDENTIFICATION:
^ Produced ID
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Form of Identification ~,
^ Personally known (Principal) ~ ~
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State of Florida, of Miami-Dad ~ ~
Swo subsc f r
Thiday _~~_
~blic Notary -State of Flor
of Principal's signature
FOR CLERK'S USE ONLY S3~S'
Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR
Lobbyist Registration Form received and verified by: Entered By:
F:\CLER\;ALL\MARIA-M\LObbyist\LOBBYISr FORM OS.doc
Revised 12/08/04
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City of Miami Bedch, 1700 Convention Center Drive, Miami Beach, Florida 33139, voww.miamibeachFl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: I" l l C,1~o, .e,
CityClerk@miamibeachfl.gov
I understand that no later than October 1st of each year, I must file the following
forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
1) Lobbyist Expenditure Form
2) Disclosure Form
Failure to file these forms on a timely basis will result in my name being transmitted to the
Miami-Dade County Commission on Ethics and for code violation evaluation.
In addition, once an issue I have registered to lobby on has been resolved, I am required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
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Signature: Date:
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