Michael W. Larkin - TD Bank fa' M IAMIBEACH
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 derision of any commissioner; any action, decision, recommendation of the
City Manager or any city board or committee; or any action, derision 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 dty commission, or a city board or committee. The term specifically indudes 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 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 mlarkin(abrzoninglaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
TD Bank
NAME OF PRINCIPAL/CLIENT:
Two Portland Square Portland Maine 04112
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(917) 282-5432
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: Gary Kaganowich, Regional Development Services Manager
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE
7 MOR OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: 5e ibit R pU LI i c i 1 f� Q (� d (7 7 ,
II. SPECIFIC LOBBY ISSUE:
Signage approvals for 350 Uncoln Road; code amendment regarding Uncoln Road Signage District
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 Department Staff, HPB, Planning Board and City
Commission* None
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* Unless an Issue is legislative in nature, HPB, BOA, Planning Board, and City Commission members are not lobbied outside btu putt heart e:,
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER
A) LOBBYIST DISCLOSURE: (Required) $ 425.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 425.00 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 pending 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 ":
ayes 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 City's Future Land Use
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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 a not - 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 a not- 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.
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.
Signature of Lobbyist: 9 Y �.
,y
Signature of Principal /Client: ,r.!__ _ � 7/� T f' j D 6
VI. LOBBYIST IDENTIFICATION:. PRINCIPAL IDENTIFICATION:
❑ Produced ID ❑ Produced ID X252 --()-9 5'6 e-3 71 r
Form of Identification Form of Identification �- ,.0--r 7- 11
X Personally known (Lobbyist) ❑ Personally known (Principal)
VII SIGNATURE AND STAMP OF NOTARY
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State of Florida, County of Miami-Dade State of F • r' - 14% -D. d -
Sworn • . nd subscribed before me Swom an su � -,�• F ore me
This r •F y of 201 This ; _ A. CHONG
r :.� W1E = State of , 7 ff,
f ►, �// ��� _ My Comm. Expires Jun 29, 5014 /
i ill Sign ture of • Notary — State of Florida Signature 1 i;i'�i` • r — .to o onda
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r No . rizati : r • Lobbyist's signature Notarization o • in p. s . n . 1 .
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1 - � FOR CLERK'S USE ONLY
Annual Registration fee .1 1 Yes [ 1 No Amo nt Paid O.O CR S o z- Date Paid 44 410
City of Miami Beach, 1700`. Convention Center Drive, MOW ; Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk @miiomibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.725A
LOBBYIST NAME: V l � het e (A) Lark - in
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
Fa ilure 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.
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Signature:: ate:
F;ICLERILQBBYIsTlLobbyfst Registration Form 32708:doc
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