Michael Larkin - Keith MeninAM BEACH
City of Miami Beach Office of the City Clerk 1 /2ttip
1700 Convention Center Drive, Miami Beach, FL 33139 n 4 7 9;
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LOBBYIST REGISTRATION FORM �.. i, `� OC _
FIQ-
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 wit 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, PA 200 South Biscayne Blvd., Suite 850 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.
LOBBYIST RETAINED BY:
Keith Menin
NAME OF PRINCIPAL/CLIENT:
Shelborne Ocean Beach Hotel Condominium Association, Inc 1801 Collins Avenue, Miami Beach, Florida 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(561) 568 -8239
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:
u.SPECIFIC LOBBY ISSUE-
Conditional Use Permit — 1801 Collins Avenue Shelborne Hotel
Issue to be lobbied (Describe in detail):
in. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2- 482(a)(4) include the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered
into any contractual relationship (paid or unpaid) with said city 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 2- 482(a)(4) Full Name of Individual and
title of person to be lobbied
Contractual Relationship (Explain)
YES
NO
Planning Department and Planning Board
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
F: \CLER \$ALL \aFORMS \LOBBYIST FORMS \Lobbyist Registration Form.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE: (Required) $445.00
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $445.00
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 Iobbvina on a present or oendina bid for aoods. eauinment or services. or on a present or pending
award for aoods. eauipment 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 Iobbvina on a pending application for a Development Agreement with the Citv or application for
chanae of zonina man designation or change to the Citv's Future Land Use Mao?
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 reoresentina a not - for - profit corporation or entity without special compensation or reimbursement
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th 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 BEACK
mg 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 ith 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:
Produced ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami -Dade
Sworn to and subscrib befo a me
This / • -y of 201
t F J
Signature of P blic Notary — State of Florida
Notarization of Lobbyist's signature
PRINCIPAL IDENTIFICATION:
Produced ID i�Vfwl"� 44*) 1
orm of Identification
�a�% BARBARA T YEE
Personally known (Principal MYCOMMISSION #EE121637
! ' EXPIRES: August 15, 2015
NlIrFOF Fl el. Bonded Thru Budget Notary Services
State of Florida, County of Miami -Dade
Sworn and subscribed b fore me
This day of , 2019.
Signature f Public Notary — State of Florida
Notariz ion of Principal's signature
TO BE COMPLETED BY CJ,TY CLERK'S STAFF ONLY
Annual Registration fee: [ ] Yes [ No Amount Paid $ '"r)+ O-J MCR
Lobbyist Registration Form rece' d and verified by:
F: \CLER \$ALL \aFORMS \LOBBYIST FORMS \Lobbyist Registration Form.doc
Date Paid 3
01/ i 2
orrn.doc Revised 1/11/2011
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: Michael W. Larkin
CityClerk @miamibeachfl.gov
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.
Pursuant to Section 2 -485 (d), the City Clerk shall notify any lobbyist (or principal) who
fails to timely file a Statement and in addition to any other penalties which may
be imposed as provided in Section 2- 485.1, a fine of $50.00 a day shall be
assessed for all Statement(s) filed after the due date. The City Clerk shall notify
the Miami -Dade County Commission on Ethics and Public Trust of the failure of a
lobbyist (or principal) to file the Statement or pay the assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30th, 2012,
shall be automatically suspended from lobbying until all fines are paid, unless
the fine has been appealed to the Miami -Dade County Commission on Ethics and
Public Trust.
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Signature: Date:
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