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Michael W. Larkin - Yossi Lipkint m MIAMI BEACH ~~~~~~ ~ ,Iss ~ 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) Berww, 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: Yossi Lipkin NAME OF PRINCIPAL/CLIENT: EDY, Inc. 1051 Washington Avenue Miami Beach, Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)332-2940 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) out tfiis section if principal is a Corporation, Partnership or Trust [Section 2-482 NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Yossi Lipkin, Elijah Levy, Doron Malinasky • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A S% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Yossi Lipkin, Elijah Levy, Doron Malinasky II. SPECIFIC LOBBY ISSUE: PB and BOA Applications in Connection with an Extension of Time for a Temporary Parking Lot Located at 1155 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., BOA, HPB, Planning Board, City Commission * None * Unless an issue is legislative in nature, HPB, BOA, Planning Board, and City Commission members are noZ o bled outside of a public hearing setting. / C..1.~ /`! i ~-~ :.i ~ ~ /BSI i ~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHER] A) LOBBYIST DISCLOSURE: (Required) ~ 375.00 per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). 5 375.00 Der 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 pending bid for goods, epuipment or services. or on a present or pendinW award for goods, epuipment 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 Wending application for a Development Agreement with the City or application for change of zoning map designation or change to the Citv's Future Land Use Map? 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 snot-for-profit corporation or entity without special wmpensation 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. _ /1.>!/ 1 Signature of Lobbyist ~,,,.....,~, x _ :~ ago .p FX ~, ~ ~"o.g~ e., fC as '~zeo~ c ~~ ~~u n a a •' 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. „ ~ ~ n Signature of Lobbyist: ~~~ V ~'/ U V Signature of Principal/Client: ,~~~' ~!!/ VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification Personally known (Lobbyist) Produced ID ~LIa' ,~~ill/~KS ~~'~~i Form of Identification ^ Personally known (Principal) 8 ,,..,~,.,. ~: _~ ~^ i, c~ri,, cb- >c o a3 b 2 ~ 3. cy', n '~ H H.. ~ H n o 3 ~' bo t-, 0 (D M ac ~d j d p o ' rr-2~~-wa~o-G' ~ is~o~'• > VII. SIGNATURE AND STAMP OF NOTARY: State State of Miami-Dade This ~O'~' tlav of. 'cn re of Public Notary -State of(~lorida nature of Public Notary - Statfi'/of Florida Notarization of Lobbyist's signature Notarization of Principal's signature FOR CLERK'S USE ONLY p~ ~jsS Annual Registration fee: [ ]Yes [ ] No Amount P 'd .3.~d ~- MCR #~f/ Date Paid ~ Lobbyist Registration Form received and verified by: Entered By: F:\CLER\$ALL\MARIA-M\LAbbyist\LOBBYIST FORM OS.da Reyis D ' ;i ' 4 { ~f l ~n z~ d~ ~. City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachFl.gov CITY CLERK Office Tel: 305.673.7411 ,Fax: 305.673.7254 CityClerk@miamibeachfl.gov LOBBYIST NAME: O`'~ t C~ae.~ (~ ~ 1-a/ltt r~ 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. Signature: ~ ~y~ ~( Date: F:ICLERILO~BYIST\Lohbyis4 Registration Form 32708.doc