Michael W. Larkin - ASR Berwick Family Ltd. Partners erl MIAMI BEACH eci� P
City of Miami Beach Office of the City Clerk 0
1700 Convention Center Drive, Miami Beach, FL 33139 C 1 e F? ://,
LOBBYIST REGISTRATION FORM `<e` 4
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat or mods tion o1$'
any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the City Manager or any city or
committee; or any action, decision or recommendation of any city personnel during the time period of the entire decision - making process on sGch,
action, decision or recommendation that foreseeably will be heard or reviewed by the city commission, or a city board or committee. The ter
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, PA 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 mlarkinObrzoninnlaw.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:
A S R Berwick Family Ltd. Partners
NAME OF PRINCIPAL/CLIENT.
A 5 R Berwick Family Ltd. Partners 4201 Collins Avenue. #1403 Miami Beach FL 33140
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 673-4981
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:
Revocable permit application and associated permitting and code enforcement issues for property located at 335 W 47 Street.
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2- 482(a)(4) include the commissioner of personnel sought to be lobbied, and whether the lobbyist
has entered into contractual relationship (paid or unpaid) with said dty commissioner or personnel from 12 months preceding
such person's commencement of service with the city to the present date, stating the general nature of the subject contractual
relationship.
Sec 2482(a)(4) Full Name of Individual and Contractual Relationship (Explain) YES NO
title of person to be lobbied
Staff of Public Works, Planning Department and None X
Building Department
City Commission, as necessary* None X
Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extent of any business, finandal, familial or
professional relationship, or other relationship giving rise to an appearance of an impropriety, with any current dty 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, 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) $435.00
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 you lobbvina 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 lobbvina on a pending application for a Development Agreement with the City or application
for change of zoning map designation or chance 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 PE IO .
Sign ture of Lob st
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 Ci o e d II r orting requirements.
Signature of Lobbyist:
Signature of Principal /Client: V.,
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
❑ Produced ID ❑ Produced ID
Form of Identification Form of Identification
Personally known (Lobbyist) - sona known (Princ - * : Pik - $t$ IS
" � � . f' 0 , ` U P 25.2012 MY Comm. VII. SIGNATURE AND STAMP OF NOTAI :4;;;, Commission • 00 02
_.� t• a� 84:4114d Terot►pti Nsti�► Mali.
State of Florida, County of Miami -Dade - State of Florida, County of Miami -D
Sworn to and subscribed before me Y33 c 8 a; Sworn and subscrib d 4.fore me
This P-14- day of Ncasisi-wyee. , 201 J_ N g g This i q day of . 20 /L
4 2 c, / ,
Signature of Public Nota — S e of Frida cs. ° Signature of Public Notary ry —State of orida
Notarization of Lobbyist's signature . A Notarization of Principal's sign. ture
ERK'S USE ONLY ...INt�
Annual Registration fee: [ ] Yes JNo Amoun Pak ! �, 6 MCR # 31 ')l R Date Paid /c 62 '�/ f
Lobbyist Registration Form received and verified by ob. • !� " .Ai -' Entered By: .1 I i
' ' Revised 1 /11 /2011
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City of Mimi Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfLgov- --
CITY CLERK Office CityClerk@miamibeachfl.gov
Tel: 305.673.741 1 , Fox: 305.673.7254
LOBBYIST NAME: /4( 1(G ed V V . Lqrk(el:
I understand that no later than February 28th of each year, 1 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.
/1/2 / /(
Signature: Date.