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Michael W Larkin - 818 Lincoln Investments, LLC ‘ive-0141-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.I) Bercow Radell&Fernandez, P.A., 200 S. Biscayne Blvd., # 850, Miami, FL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-377-6231 305-377-6222 MLarkinaBRZoninaLaw.corn TELEPHONE NUMBER: FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone,ore-mail address. I. LOBBYIST RETAINED BY: Dannu Lavu, MGR NAME OF PRINCIPAL/CLIENT: 818 Lincoln Investments, LLC-3510 St. Joseph Boul East Montreal. Quebec H1X 1W6, CANADA BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (514)223-5459 c/o Kim Cienki kcienki(ushiller.ortticorn. TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional) 4�i • t� Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)] • NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: Danny Lavy, MGR • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, it PARTNERSHIP OR TRUST: See Exhibit A, attached. °.SPECIFIC LOBBY ISSUE: '• Development Approvals and Permitting Issues, including, but not limited to the Historic Preservation Board, Plenning Board, Board of Adjustment, Land Use Development Committee, and City Commission, if necessary, relating to the property located at 818 Lincoln Road, Miami Beach. FL. Issue to be lobbied(Describe in detail): Ill. 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 Planning, Building, Public Works and Fire Department None X Staff PB, HPB, BOA, City Commission, and Land Use None X Development Committee, as necessary 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 None None IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required): $500.00 per hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):$500.00 per hour (REQUIRED). 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 lobbying on a present or oendina bid for aoods.eauioment or services.or on a present or pending award for aoods.eauipment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes X No: Are you lobbvina on a nendina application for a Development Aareement with the City or application flg change of zonina map desianation or chanae to the City's Future Land Use Map? 3) Pursuant to Miami Beach City Code Section 2-482(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 o: Are you representina 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 EQg 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 reporting requir- -nts. Signature of Lobbyist: Signature of Principal/Client: VI. LOBBYIST IDENTI • •N:/ PRINCIPAL IDENTIFICATION: J Produced ID ,: Produced ID Form of Identification Form of Identification x es 4- /Personally Personally known(Lobbyist) 3 s known(Principal) VII. SIGNATURE AND STAMP OF NOTARY: • stele-vf-F1BTteta, ecrarliade o Sworn to an• subscribe b fore me MU• ( )/ Swor a•d subscribe before me This of ,201 This day of c-+ ,,201 LATMA _ -" , Sig -° re o �licr 7otary- ' - • ori•a Signature of Public Notary-Statgt F�larida No :rizatio�•Lobbyist's signature "" ._ Notarization of principal's signature TO BE COMPLE DY CITY CLERK'S STAFF ON 9// S - dnnual R.3latratinn f..• ;Ypc t .Mn amount Pairs$ d MCR ��7 flat.Pairi* Lobbyist Registration Form received and verified by _ CLIV ' istratton Form.doc Revised 04/27/2012 Y B A City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Rafael E.Granado, City Clerk CityClerk a miamibeachfl.gov Tel: 305.673.7411 , Fax:305.673.7254 LOBBYIST NAME: Michael W. Larkin I understand that no later than February 28 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, or I am no longer lobbying on that issue or for that principal, 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. r I Signature Dat • EXHIBIT A DISCLOSURES 818 Lincoln Investments, LLC 3510 St. Joseph Boul East, Montreal Quebec, H1X 1W6, CANADA CORPORATION NAME AND ADDRESS NAME AND ADDRESS %OF STOCK Lincoln 818 Real Estate 50% C/O 20295 NE 29th Place, Ste. 200 Aventura, Florida 33180 Mariposa Real Estate, LLC 50% 2711 Centerville Road, Ste. 400 Wilmington, Delaware 19808 Lincoln 818 Real Estate C/O 20295 NE 29th Place, Ste. 200, Aventura, Florida 33180 CORPORATION NAME AND ADDRESS NAME AND ADDRESS %OF STOCK Shilldev(US), Inc. 50% 111 S. 17th Avenue Hollywood, Florida 33020 Danlav Lincoln Properties Corp. 50% C/O 20295 NE 29th Place, Ste. 200 Aventura, Florida 33180 Shilldev (US)Inc. 111 S. 17th Avenue, Hollywood, Florida 33020 CORPORATION NAME AND ADDRESS NAME AND ADDRESS %OF STOCK Stephen Shiller 100% 111 S. 17th Avenue Hollywood, Florida 33020 Danlav Lincoln properties, Inc. C/O 20295 NE 29th Place, Ste. 200, Aventura, Florida 33180 CORPORATION NAME AND ADDRESS NAME AND ADDRESS %OF STOCK Danny Lavy 100% C/O 20295 NE 29th Place, Ste. 200 Aventura, Florida 33180 Page 1 of 2 Mariposa Real Estate, LLC 2711 Centerville Road, Ste. 400, Wilmington, Delaware CORPORATION NAME AND ADDRESS NAME AND ADDRESS %OF STOCK Martin E. Franklin 100% 5200 Blue Lagoon Drive, Suite 855 Miami, FL 33126 Page 2 of 2 - 16 -`gy . '.. s = . \ ,r. `a ®�._ -N _•: v = 2 - . s° 4i i 1, - _ .- :U) 43- :__ 0 - ti _z -..,4, , , -. , H - - -- 0 2 - - D - \ ' - 0- ' ''E - '''j �. ._ L Z i i - Ti-0.. - c r i -r 21 --f — -- A_ r-- • =--' ---- •§---- ''' -'-'''• a C�.. _