Michael W. Larkin - Russell W. Galbut I Ilk
T MIAMIBEAC H
City of Miami Beach Office of the City Clerk I V
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1700 Convention Center Drive, Miami Beach, FL 334/ Sep
6 Q ty 0
LOBBYIST REGISTRATION FORM T Y - R k , t, S3
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, er e E
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)
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 mlarkinbrzoninglaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Russell W. Galbut
NAME OF PRINCIPAL/CLIENT:
730 First Street Associates, LLC 2200 Biscayne Boulevard Miami Florida 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 573-4127 (305) 305 573 -8489 rgalbutOcrescentheights.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:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
- II. SPECIFIC LOBBY ISSUE:
Development Approvals with Regard to Proposed Mixed -Use Building to be located at 730 -804 First Street, Miami Beach, FL
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED:
- f
A) Full Name of Individual /Title B) Any Financial, Familial or Professional Relationship
Okin/ D C'tc 661 etVei 6: / 4,4
ti
* Unless an issue is legislative in nature, HPB, BOA, Planning Board, and City Commission members are not lobbied outside of a public hearing setting.
r1 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION ( DISCLOSE WHETHER HOURLY,
''FLAT RATE OR OTHER
A) LOBBYIST DISCLOSURE: (Required) $ 435.00
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ C
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 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 CO ENSATION DURING THE
REPORTING PERIOD.
nature 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: PRINCIPAL IDENTIFICATION:
Produced ID '-'Produced ID v' 6 1-iCe :. Hp
Form of Identification Form of Identification d �;►
/Personally known (Lobbyist) Personally known (Principal) Q �' O " •'`
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I. SIGNATURE AND STAMP OF NOTARY: 72. C7 u
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e. w o' .te of Florida, County of Miami -Dade State of Florida, County of Miami -Dade o �• � �•
Y . orn t nd subscrib b ore e Sworn subscri d ore m o
• o is of 20 This Of day of f �' a o co Li
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za�w a
• nature of Public Notary — State of Florida Signature o Public Notary — State of Florida
. otarization of Lobbyist's signature Notarization of Principal's signature
04.01' FOR CLE K'S S ONLY
nual Registration fee: [ ] Yes [ ] No Amount Pai MCR # -3/4 Date Paid q /./
Lobbyist Registration Form received and verified by: Entered By: Wiig
F: \CLER \$ALL \MARIA -M \Lobbyist \LOBBYIST fORM 05.doc Revised 12/08/04
- -fir• , 1
MiAMIBEACH
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: / k4,e! d
I understand that no later than February 28th 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 9
Signature: Date:
We are committed to providing excellent public service and safety to all who live, work, and play in our vibrant, tropical, historic
community
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