Michael W. Larkin - Meir Srebernik f
I
M IAMI BEACH Ia S u 0
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)
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@brzoninglaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Meir Srebernik
NAME OF PRINCIPAL /CLIENT:
Palau Sunset Harbor, LLC 900 Biscayne Blvd., #2802 Miami Florida 33132
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305 514 0818
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: c.) o
Development of the Property at 1201, 1225, and 1237 20 Street, Miami Beach, Florida
Issue to be lobbied (Describe in detail): .
III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED: — m
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A) Full Name of Individual /Title B) Any Financial, Familial or Professional RelatTpnshil .. I
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* Unless an issue is legislative in nat , HPB, BOA, Planning Board, and City Commission members are not lobbied outside of a u li h
p b c hearing setting.
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). $ 435.00
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 Iobbvinq 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 vou 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 COM E SATION DURING THE
REPORTING PERIOD.
Signature o obbyist
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 Bach City Code and all reporting
requirements.
Signature of Lobbyist:
Signature of Principal /Client:
VI. LOBBYIST IDENTIFICATION: )/ PRINCIPAL IDENTIFICATION:
❑ Produced ID Produced ID
+ Form of Identification Form of Identification
Personally known (Lobbyist) )ersonally known (Principal
. SIGNATURE AND STAMP OF NOTARY: , :;4"
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otarization of Lobbyist's signature Notarization of Principal's signature
FOR CLERK'S USA ONLY 1 //,
Annual Registration fee: [ ] Yes [ ] No Amount Paid '3,3- MCR # �1 3o ') Date Paid
Lobbyist Registration Form received and verified by: Entered By� ../� � MI ••
F' \CLER \$ALL \MARIA -M \Lobbyist \LOBBYIST fORM 05.doc -
R: iced 12/18/04
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City of Miami Beach, 1700 Convention Center dove, Miami Beach, Florida 33139, www miamibeachfl.gov
CITY CLERK Office CityClerk@miarnibeachfl goy
Tel 305 673 7411 , Fax 305 673.7254
LOBBYIST NAME: g1OrtetP (fAitt lY
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.
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Signature: Date: