Michael W. Larkin - Peter and Andrea Russin el MIAM!
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)
200 S. Biscayne Blvd., Ste. 850 Miami Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305 - 374 -5300 305- 377 -6222 mlarkin @brzoninglaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes: address, phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Peter and Andrea Russin
NAME OF PRINCIPAL /CLIENT:
5170 La Gorce Dr Miami Beach Florida 33140
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 358 -6363 (305) 358 -1221 prussin @melandrussin.com
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: N/A
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: N/A c", ev
II. SPECIFIC LOBBY ISSUE: -<
a
ment and permitting issues and approvals, 'r
Development p g pprovals, including variance application, and associated matters for 5170 La Gorce DrtT' n, ^'
Issue to be lobbied (Describe in detail): Crl 7l
III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED: o
Pursuant to City Code Section 2- 482(a)(4) include the commissioner of personnel sought to be lobbied, and Walther lobbyist
has entered into contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 manthsWeced ng
such person's commencement of service with the city to the present date, stating the general nature of the subjecttractual
relationship.
Sec 2482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES NO
title of person to be lobbied
Planning Department Staff None X
Planning Board, BOA, City Commission* None X
Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extent of any business, financial, familial or
professional relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner
or city personnel who is sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2- 482(g) Any Financial, Familial or Professional Relationship
None.
* Unless an issue is legislative in nature, HPB, BOA, Planning Board, and City Commission members are not lobbied outside of a public hearing setting.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
- OTHER)
A) LOBBYIST DISCLOSURE: (Required) $435 hourly
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $435 hourly
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 vou 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 ":
❑Yes X No: Are vou 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 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 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 FEBRUARY 28 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 PERIO . (/,
/y ;
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 B- •de . , d all reporting requirements.
Signature of Lobbyist: ,
Signature of Principal /Client: =
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
❑ Produced ID [1 Produced ID
Form of Identification Form of Identification
personally known (Lobbyist) [V'Personafly known (Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
I S of Florida, County of Miami -Dade State of Florida, County of Miami -Dade
.*Sr to and subscribed before me Sworn and subscribed before me
•
.f . i /. C 41 201 This L'I" day of.t/C.1 , I a) ...w,,
, 1 .1j- 1 FP' li = Dk 1 n_' n; ..tNANDEZ
y / t� ' EiS5i0r a EE 025991
t :� re of P r otary — State of Florida Signature of Public Notary — St '? � 1 : E ` 3S a, 401
ization of Lobbyist's signature Notarization of Principal's s " ry PUn
R
FOR CLERK'S USE ONLY „
� Reg is tration fee: [ ] Yes [ ] No Amount Paid 3 S� MC # i � Date Paid „® /
. . P 1. 1
4 .„ .t Re F orm rece and verified by: Entered By:
"till �� AIWA Revised 1/11/2011
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
. OTHER)
A) LOBBYIST DISCLOSURE: (Required) $435 hourly
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $435 hourly
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 ":
❑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 City'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 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 FEBRUARY 28 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 PF D. r /
Signature of obb '
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 • mi Be Mode Code and all reporting requirements.
Signature of Lobbyist:
Signature of Principal /Client: 7
VI. LOBBYIST IDENTIFICATION: ' PRINCIPAL IDENTIFICATION:
❑ Produced ID ❑ Produced ID
/ Form of Identification Form of Identification
[� Personally known (Lobbyist) ,P sonally known (Principal)
"
VII. SIGNATURE AND r N •rt i D GONZALEZ
f ION #DD 960888
�
• ---.: 6 t EXPIRES: March 23, 2014
State of Florida, County of Mi ie BondedThru Notary PubhcUnderwritegta,e of Florida, County of Miami -1 1 77, '
pg IRENE HERNANDEZ
Sworn to and subscribed befo rn a me day of
nd subscribed before me tr: im r MY COMMISSION # EE 025991
This q1 day of - ..
ac-(L- , 20 t This y C h , 20 I `� EXPIRES: December 4, 2014
/ \/�},� u v ,ls, :., ded Thru Notary Public Underwriters
�C O-A- • V
Signature of Public Notary St of FI ida Signature of Public Notary — State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
FOR E USE ONLY
Annual Registration fee: [ ] Yes [ ] No Amount Paid -' — MCR # 507 I Date P. d • / C
�
Lobbyist Registration Form received and verified by: Entered By: d
Revised 1/11/2011
I we
MiAM1BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: / 4dL4d W, Z.C3f
I understand that no later than February 2 t
rY 8 h of each year, I must file the following form, 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 and Compensation 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.
/'1 3 Signature: at 3ft