Michael W. Larkin - Victor Victoresm 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 aty personnel during the time
period of the entire decision-making process on such action, decisio or recommendation that foreseeably will be heard or reviewed
by the city comma ion, or a city board or committee. The term sp cifically includes the principal as well as any employee engaged
in lobbying activities. The teen "Lobbyists" has specific excl ions. 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:
Victor Victores
NAME OF PRINCIPAL/CLIENT:
Sabadell United Bank Sgm Miami Lakes Drive East Miami Lakes Florida 3 014
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-820-5366
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~~V.IIVIYL IY VI'IDGR.
hAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out thissection if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• 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:
Amendment to Settlement Agreement Concerning Outdoor Sign Located at the South East Comer of the Intersection of Arthur
Godfrey Road and Alton Road, Miami Beach, Florida
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
Board of Adjustment
B) Any Financial, Familial or Professional Relationship
IV. DISCLOSURE OF TERMS
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Require
B) PRINCIPAL'S DISCLOSURE (OF LO
The following information mu,
1) Pursuant to Miami Beach
On Procurement Issues":
AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
X425/hour
COMPENSATION): (Required). $425/hour
be answered:
Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
Mao?°?
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 corooration or entity ~.+ithout 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.
S' nature of Lobbyist
o Produced ID
Form of Identification
~ Personally known (Lobbyist)
~~
s
$ VII. SIGNATURE AND STAMP OF NOTARY:
,;;~ State of Florida, County of Miami-Dade
~~ Sworn to and subscrib efore me
~ This ~_d of ~ ZO ll7
~~ Sign ure of b No ary -State of Florida
Not rizatio Lo byist's signature
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. /J,,~ ~ „
Signature of Lobbyist: / (/ i
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
~i Produced ID dr I J~ r ~ s i+ l~clns~
Form of Identification
^ Personally known (Principal)
State of Florida, County of Miami-Dade
Sworn and subscrib before me
This ~Z _day , 20 O -
Signature of Publi ry State of Florida
Notarizati n of cipal's signature
~~
~y, g.
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FOR CLERK'S USE ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # Date Paid
Lobbyist Registration Form received and verified by: Entered By:
F:\CLER\;ALL\MARIA-M\LObbyist\LOBBYIST FORM OS.da
ReWSed 12/08/04
City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachFl.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fax: 305.673.7254
C ityClerk@miam ibeachfl.gov
Acknowledgement of fines/suspension from lobbying for failure to
comply with City of Mi®mi Beach lobbying Laws
LOBBYIST NAME: ~ l - ~ I' i a ~ ~ ~~ ~ A ~ k - n
I understand that no later than October 1st of each year, lobbyists subject to lobbyist
registration requirements shall submit to the city clerk a signed statement under oath
listing all lobbying expenditures, as well as compensation received, for the preceding
calendar year with regard to the specific issue on which the lobbyist has been engaged
to lobby. A statement shall be filed even if there have been no expenditures or
compensation during the reporting period.; The statement shall list, in detail, each
expenditure by category, including food, and beverage, entertainment, research,
communication, media advertising, publications, travel, lodging and special events.
FAILURE TO TIMELY FILE THE EXPEN®ITURE AND FEE DISCLOSURE REPORT
WILL RESULT IN A FINE OF $50.00 PER DAY. ANY LOBBYIST WHO FAILS
TO FILE THE REQUIRED EXPENDITURE REPORT BY DECEMBER 1, SHALL
AUTOMATICALLY BE SUSPENDED FROM LOBBYING UNTIL ALL FINES ARE
PAID, UNLESS THE FINE HAS BEEN APPEALED TO THE MIAMI-DADS COUNTY
COMMISSION ON ETHICS AND PUBLIC TRUST. In the event a lobbyist fails to
either file the report and/or pay the assessed fines, the Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust.
IN ADDITION, ONCE AN ISSUE 1 HAVE REGISTERED TO LOBBY ON HAS
BEEN RESOLVED, 1 AM REQUIRED TO IMMEDIATELY NOTIFY THE CITY
CLERK'S OFFICE OF LOBBYIST WITHDRAWAL IN WRITING.
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Signature: Dater