Michael W. Larkin - 14 La Gorce, LLC MIAMI BEACH �a.
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.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 miarkinca-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:
14 La Gorce LLC
NAME OF PRINCIPAL/CLIENT:
90 Amelia Avenue Coral Gables Florida 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)445-4458 (305) 445-4458 tom @uniontitleservices.com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2482(c)]
• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: Please see attached Exhibit A.
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 and Permitting Issues for 14 La Gorce LLC
Issue to be lobbied(Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
N
Pursuant to City Code Section 2-482(a)(4)include the commissioner or personnel sought to be lobbied,and whether t—lob C:::)ist has entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months rprecei9irrg such
person's commencement of service with the city to the present date,stating the general nature of the subject contract al relaitonshi
Sec 2482(a)(4)Full Name of Individual and Contractual Relationship(Explain)r r YES NO
title of person to be lobbied - `
Planning Department and Building Department Staff None ` X
B, D1ZB, BOA, City Commission, as necessary one X
T; � ,;�
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Pursuant to City Code Section 2-482(8)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 2482 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)$475.00
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(Required). $475.00
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":
Are you lobby* nt or nendmna bid for goods.eau"mment or r-esent or penciffina
award for goods.eauioment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
eyes (L No:) Are you lobbying on a pending aoolication for a Development Agreement with the City or aoolication for
chanae of zonina map designation or chanae to the City'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 1LNo:)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 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 with the provisions contained
in Section 2-482 of the Miami Beach City Code and all report' quirements.
Signature of Lobbyist: /I J Zz)"
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
IE Produced ID € Produced ID
Form of Identification Form of Identification
1E Personally known(Lobbyist)- € Personally known rincipal)
t�1,lN 6 0 6!10 01l �
VII. SIGNATURE AND STAMP OF N 10 �pRTINOq� *z
a�+rPr v,.4; CRISTINA D.GON ZALEZ
State of Florida,County of Miami de ' MY COMMISSION#DO 960668 State of Florida, County of Blii`a�Ut e e s °�
Sworn to and subscribed before me !i� ; ,F _,.r=
EXPIRES:March 23,2014 Sworn a subscrib�,d bef� rTlg
01 _._•;-___.Gondcd Thru Notary Public Underwriters e g This f This )I � day of ��i�� 2
Signature of Public Notary Statetbf Flon Ignature of Public Notary—S ate ol F , UgLIC°S�P� �.ti
Notarization of Lobbyists signature Notarization of Princioal s signature terlP�l3il�9:{St
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid MCR# Date Paid L
Lobbyist Registration Form received and verified by: c
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form. oc
' C i,nn.duc Revised 1/11/2011
City or Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33 139,%"vw.miamibeachfl.gov
CITY CLERK Office CityClerkamiamibeachfl.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-Dade County Commission on Ethics and Public Trust.
b -7 3
Signature: Date:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
Exhibit A
14 LA GORCE LLC
Name & Address Percentage of Stock
Lynmarsh Investments Limited 99.9%
Geneva Place Waterfront Drive
P.O. Box 3175, Road Town
Tortola, British Virgin Isles
Brett Palos 0.01%
100 George Street, London W1U 8NU
LYNMARSH INVESTMENTS LIMITED
Name & Address Percentage of Stock
Lynmarsh Trust 100%
I
LYNMARSH TRUST
Name & Address Percentage of Stock
Beneficiary: Cristina Green 100%
24 Avenue Princess Grace, MC 98000, Monaco
Trustees: Appleby Services, Ltd.
22 Victoria St., Hamilton, HM EX, Bermuda
Individual Directors of Appleby Services, Ltd., Kiernan Bell, Timothy Faries,
Rory Gorman, Rodney Boddy, Bradfield Adderly, Cameron Adderly, Farah Ana
Ballands, Timothy Counsell, and Frances Woo.