Michael W. Larkin - Joe Little~,
~ MIAMIBEACH
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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 tl
or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recor
City Manager or any city board or committee; or any action, decision or recommendation of any city personn
period of the entire decision-making process on such action, decision or recommendation that foreseeably will be
by the city commission, or a city board or committee. The term specifically includes the principal as well as any
in lobbying activities. The teen "Lobbyists° has specific exclusions. Please refer to Ordinance 2004-34
Larkin
Michael
e, defeat
~n of the
the time
reviewed
engaged
NAME OF LOBBYIST: (Last) (First) ~ (M.I)
i
Bercow, Radell & Fernandez, P.A. 200 South Biscayne Blvd., suite: 850 Miami, Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) ; ;j (Zip Code)
(305) 377-6231 (305) 377-6222 mlarkin@brzoninglaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL: li
I. LOBBYIST RETAINED BY:
4'
Joe Uttle !~
NAME OF PRINCIPAL/CLIENT:
CBS Outdoor Inc. 2640 NW 17"' Lane Pompano Beach Florida 'I 33064
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) {' ~ (Zip Code)
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Ootiorial)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] j:
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Wally Kelly, President ~.
r: ,.
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• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST!IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: CBS Corporation ~
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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):.
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III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
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A) Full Name of Individual/Title ~.i ~
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B) Any Financial, Familial or Professional Relationship
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Ci Commission
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Mana er's Office ~. ;
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Plannin Staff
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required) $425/hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $425/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 lobbving on a present or pending bid for goods, equipment or services, or on a
eresent or pending award forgoods, 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 pending 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
Man?
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 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.
- Signat~lfre 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/Client:
VI. LOBBYIST IDENTIFICATION!
^ Produced ID
~ Form of Identification
t~ Personally known (Lobbyist)
Y VII. SIGNATURE AND STAMP OF NOTARY:
g~ State of Florida, County of Miami-Dade
• Sworn to and subscribed before me
. ~ This 4 da of , 20L
~ Sig a ure ub is Notary - S to of Florida
~ ~„~ Notarization of Lobbyist' signature
State of Florida, County of
Sworn and subscribed befc
This? ~y of„~
Signature of Public Notary -State of Flor
Notarization of Principal's signature
FOR CLERK'S--v~NLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR #3~S'g Date Paid
Lobbyist Registration Form received and verified by: n ntered By:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM OS.doc ~~ ~ ~, _
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
~-'Personally known (Princi'®°°°
CAROLYNN WILLETT
Notary Public -State of Florida
MY Commission Expires Feb 19, 201
.Commission # DD 760104
Revised 12/08/04
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City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachil.gov
CITY CLERK Office
Tel: 305.673.741 1 ,Fax: 305.673.7254
CiyClerk@miam ibeachfl.gov
Acknowledgement of tines/suspension from lobbying for failure to
comply with City of Miami Beach lobbying Laws
/^
LOBBYIST NAME: ~ I C ' ` A ~~ V V ~ ~~ rk / 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 EXPENDITURE 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 sha(I notify the Miami-Dade
County Commission on Ethics and Public Trust.
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:
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