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Michael Larkin / Ronald Finvarb _ City f Miami Beach Office of the City Clerk ry Y Y 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.1) 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. I. LOBBYIST RETAINED BY: Ronald Finvarb NAME OF PRINCIPAL/CLIENT: SOBE 17, LLC 1065 Kane Concourse, Ste. 201 Bay Harbor Islands Florida 33154 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 861-3500 (305) 861-3555 ronald@finvarb.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: Developmental Board Approvals for SOBE 17, LLC - 1231/1251 17 Street and parking requirements. Issue to be lobbied(Describe in detail): nl. 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 Contractual Relationship(Explain) YES NO title of person to be lobbied Commission, Planning Staff, Development Boards None X Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the.e!Jegt_ofia yl�gs=f.fin�a cial,familial or professional relationship,or other relationship giving rise to an appearance of an impropriety,with'any current city 'i 'n6r 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 80 T Rd 92 O N/A a 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 No: Are you lobbying on a present or rending bid for goods,eauipment or services.or on a present or pending award for goods. eguiQment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": Yes No: Are you lobbying on a pending for a Development Agreement with the City or application La 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 No: Are you representing 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 BEACH EM THE PRECEDING CALENDAR YEAR, A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR CQMPEbISAIIQN DURING THE 13EPQRTIN i' 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 Beach Cit de and reporting requirements. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: o �d4 N • 4. Produced ID °. Produced ID "' 4 Z Form of Identification °ooa.7 Form of Identification mCpZ Personally known (Lobbyist) X.0 5 � /Personally known 0 sO y O d O H CO A a-i Q O (Principal)VII. �a � SIGNATURE AND STAMP OF N m 2. C O N T� NOTARY: ' ( `� �d T �m L"m 0 0 ao State of Florida, County of Miami-Dade 6 State of Florida, County of Miami-Dade Sworn t d subscrib d befo me Sworn d subscrib of r me This ay of , 2012 �Thi � day of , 2012 K Ai�' �AM )' Sig ure of Public Notary—State of Florida Signa ure of Public Notary—State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# 7 Date Paid v l Lobbyist Registration Form received and verified by: 9th 1%\/\ A/\/\ I BE AC �-! City of Miami Beach, 1 700 Convention Center Drive. Miami Beach, Florida 33 139,w\«v.miamibeachfl.gov CITY CLE-RK Office CityClerk((-i?miamibeaclin.gov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: Michael W. Larkin 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-Dad County Commission on Ethics and Public Trust. Signature: Dat . F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc