Michael W. Larkin/ Alan Waserstein (2)/20/ Col/iW-1
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.
Larkin Michael W.
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) 377-6231 (305) 377-6222 mlarkin@brzoninglaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Alan Waserstein
NAME OF PRINCIPAL/CLIENT:
12th and Collins Real Estate, LLC 6001 NW 153 Street, Suite 110 Miami Lakes Florida 33014
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 827-8373 wasrco@aol.com
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: Alan Waserstein
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: Alan Waserstein
II. SPECIFIC LOBBY ISSUE:
Extension of Time for Temporary Parking Located at 1201 Collins Avenue
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
Planning Dept., BOA, HPB, 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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F7_.4T RATE OR OTHERr
A) LOBBYIST DISCLOSURE: (Required) ~ 375.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 375.00 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 equipment or services or on a
present or Wending 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 vending application for a Development Agreement with the Citv or
application for change of zoning map designation or change 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-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. ~J~/~/~ /
Signature of Lob yist
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 i~~/ 12-482 01~ the Miami Beach City Code and all reporting
requirements. f 1/ 1 I I ~., ~ _.~_ ,~
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
Produced ID ~
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of , 20_
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
Produced ID
Form of Identification
Personally known (Pri '
TERESA L MARQUES
y,; ,R MY CAMMISSION M DD 653705
• ' EXPIRES: April 3, 2011
•••~y Bonded Thnt Notary PuMk Uidervrtlters
State of Florida, County o
Swor and subscribed b fore me ~,o~
This day of ~~_, 20V t
Signature of Public Notary -State of Florida
Notarization of Principal's signature
FOR CLERK'S USE ONLY
Annual Registration fee: [ Yes [ ] No Amount Paid b%~D MCR #
Date Paid D
Lobbyist Registration Form received and verified by: Entered By: L'L ~,~~~
F:\CLER\$ALL\MARIA-M\LObbyist\LOBBYIST fORM OS.doc '~ Revised 12/08/04
City of lNiami Beath, 17C?(? Convantian Canter Drive, Ntiami Beoc!~, Florida 33139, wwvv.mtam~bea~i}~,gov
CIiY C1ERK t~~fice CilyClerk~m;amibeachfi.gov
TeP: 305_b?3.741 1 ,Fax: 3t?S.b73.?25d
LOBBYIST NAME: M \ C1~Ck,Q ~ L~,l ~C~ t\
understand that no later than October 1st of each year, I must file the following
farms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
l } Lobbyist Expenditure Farm
2) Disclosure Form
failure to file these forms an a timely basis will result in my name being transmitted to the
Miami-0ade County Commission an Ethics and far Cade violation evaluation.
In addition, ante an issue I have registered to lobby on has been resolved, { am required
to immediately notify the Gty Clerk's Office of lobbyist withdrawal in writing.
Signature: Date:
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