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Michael Larkin - 3925 Collins AvenueD~- ~ MIAMI BEACH ~~ ~ vs 3 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 enrnurage 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) Bermw, Radell & Fernandez, P.A. 200 S. Biscayne Blvd., Suite 850 Miami Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 377-6231 (305) 377-6222 mlarkinCo~brzoninolaw com ~ TELEPHONE NUMBER: FAX NUMBER: EMAIL: ' I. LOBBYIST RETAINED BY: Beta Epsilon/Cadillac, LLC, contact: Dan Economos ' NAME OF PRINCIPAL/CLIENT: BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) Code) (561)361-3918 (561)361-3945 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] i • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Nicholas Economos, Manager ~ • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See Exhibit B rr cne~•rrn ~ ~nnv :e.e...~ New ground floor addition, including mechanical parking lifts, at the Cadillac Hotel located at 3925 Collins Ave 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 Department Staff, HPB, BOA, Planning Board and City Commission* None ~ i F ,.l u . Ji ~„ ~ i ~^ * UIIIESS Flfl ICGIIP IC IPl11CIaYI~iG in n~fi ire 41DC Glll1 el,....:-- o ..I ...: _..~ ' .... ~~ ~ . ~.- e - - - _ ---~-~ -••- _.., _.....,,,.__,...~ ~~~~~~~..~~~ a~~ ~~~~ ivuuicu wuwe of a puonc neann i ~5~ IiV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HO[/RLY, FLAT RATE OR OTHERf A) LOBBYIST DISCLOSURE: (Required) $ 425.00 Der hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 425.00 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 oendina bid for goods equipment or services or on a present or oendina 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": Ma°? 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 reoresentana anot-for-profit corporation or entity without sueciail compensation or reimbursement. I 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 RECENED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR,~OMPENS/~ON DURING THE REPORTING PERIOD. /1 ~ ~ /11\ Signature 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. /I , ^~ , ~ ~- Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: Produced ID ~° Form of Identification `° o~ ----- ~ Q o Personally known (Lobbyist) (q N C ~~~ VII. SIGNATURE AND F NOTARY: ~ ~ ~ ~ ._ Z Q ~ x W State of Florida, County of Miami-Dade Sworn to a d subscribed before me ' ~ ~J~ • ~odo Th day o ~ 20 l o ~ n O ~J ~op ~ ~PC~ Sign a of Public No - S to of Florida Notarization of Lobbyist's signature Produced ID IDENTIFICATION: IMo+nasv « c. Personally known (Principal) L I State of Florida, County of Miami-Da °~~•p.°,~ ' DEBRAALMNGSTON * *i MY COMMISSION t DD 681826 Sworn a subscribed be ore me ~ ExPiRES: May 13, 20tt Thisd of J OLd+,~~~°e~O~ eondeaThrueudgatrmmryServkes ~ t^ 'l Signature of Public Notary -State of FI a Notarization of Principal's signature FOR CLERK'S USE ONLY G ~ i ~~ Annual Registration fee: [ ]Yes [ ] No Amount Paid ~~ Q_ MCR # I ~ Date Paid Lobbyist Registration Form received and verified by: Entered By: ! f:\CLER\$ALL\MARIA-M\Lobbylst\LOBBYIST fORM OS.doc Revised 12/08/04 Cco,.~-~-5 - k`i f € 4 ' F: R F +ers{ Pte- ~ - ~ ~ f''~~ K T `1 ~ ° i w ~ F~ I ~ ~¢ s r - ~ ~ gym` ...-a- F -~,++~s ._ E~ :. City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachFl.gov CITY CLERK Office CityClerk@miamibeachfl:gov . Tel: 305.673.741 1 ,Fox: 305.673.7254 Acknowledgement of fines/suspension from lobbying for failure to comply with City of Miami Beach-lobbying Laws 10BBYIST NAME: l C~~ ~. LQr'l~l/1` 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 fall's to .either file the report and/or pay the assessed fines; the Clerk shall notify the Wliaml-Dade County Commission on Ethics and Public Trust. IN ADDITION, ONCE AN ISSUE 1 HAVE REGISTERED TO LOBBY ON HAS . BEEN RESOLVED, I AM REQUIRED TO IMMEDIATELY NOTIFY -THE CITY CLERK'S OFFICE OF LOBBYIST WITHDRAWAL IN WRITING. ~ - ~ ? Z`~ ~~ Signature: Date: EXHIBIT B DISCLOSURE OF INTEREST for Beta Epsilon/Cadillac, LLC 4000 N. Federal Highway, Suite 2i Boca Raton, Florida 33431 NAME OF INTEREST HOLDER 1. Stanley Daniel Economos 4000 N. Federal Highway, Suite 206 Boca Raton, Florida 33431 2. Nicholas Economos 4000 N. Federal Highway, Suite 206 Boca Raton, Florida 33431 3. Alexandra Yessios 4000 N. Federal Highway, Suite 206 Boca Raton, Florida 33431 4. Chris Yessios 4000 N. Federal Highway, Suite 206 Boca Raton, Florida 33431 5. George Bavelis 4000 N. Federal Highway, Suite 206 Boca Raton, Florida 33431 6. Beta Epsilon/Cadillac, Inc. a Florida Corporation 4000 N. Federal Highway, Suite 206 Boca Raton, Florida 33431 a. Nick Economos 4000 N. Federal Highway, Suite 206 Boca Raton, Florida 33431 TOTAL for Beta Epsilon/Cadillac, Inc. .. __ TOTAL.for Beta Epsilon/Cadillac, LLC 100% 100% 0.50% 100.00