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Michael W. Larkin - Mathieu Massa DocuSign Envelope ID:0208D2FD-B487-4eE7-8A96-C952C8CDAC95 S5o - (� RECEIVED W o I EJUL 27 2020 Office of the City Clerk 1700 Convention Center Drive CITY OF MIAMI BEACH Miami Beach, FL 33139 OFFICE OF THE CITY CLERK 305.673.7411 LOBBYIST REGISTRATION FORM Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat cc modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recanmendation 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, derision.or recommendation that foreseeably will be heard or reviewed by the City commission, or a Cityboard or committee. The term specifically includes the principal as well asany employee engaged in lobbying activities. The term 'Lobbyists'has specific exclusions. Please refer to City Code Chapter 2, Artide VII, Division 3, entitled"Lobbyists,' for additional information. Instructions: Please complete all sections of this form and submit the completed form,with the applicable fee,to the Office of the City Clerk. If you need more space to complete an answer, use a separate sheet(s) of paper. If you have nothing to report in a particular section, you must write "none" or "n+/a" in that section. Any change to any information originally filed, or any additional City Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amendment to the registration form. The lobbyist has a continuing duty to supply information and amend the forms filed throughout the period that thelobbying occurs. Separate registration forms shall be required for each principal represented on each specific issue. I. LOBBYIST INFORMATION: Larkin Michael W. NAME OF LOBBYIST (Last) (First) (Middle Name) Bercow Radell Fernandez Larkin&Tapanes, PLLC 200 South Biscayne Blvd.,Ste. 850 Miami, Florida 33131 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (Stag) (Zip Code) (305)374-5300 ml ark inebrzoninglaw.corn LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS IL PRINCIPAL INFORMATION: Massa Mathieu NAIVE OF PRINCIPAL (Last) (First) (Middle Name) 550 Landlord,LLC 999 Brickell Avenue,Suite 3600 Miami Florida 33131 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City; (State) . (Zp Code) (305)510-0142 mmassa©massainvestment. corn 0 PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS a •urr- suont(te5ciW er do Sootion 2-492(h)(f�(a'.;A principal o any'capor_cn;partnership;or`othar:aroti +;w;• appears.as a IobI591s Af n a entity,w thcut special comoensatien C?r:imbursement fort p appeareneee,whether Urect,indirect.'6:m1 gent,to exa ass su•.ort of or.e.ositlon to N i shall register MOD re•uired by this subsectionbutshalihet tare uireditoiM an registration°ees. If the principal is a Corporation, Partnership or Trust, the following information MUST be provided pursuant to City Code Section 2-462(c): NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY(if none,write N/A): Mathieu Massa . NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,PARTNERSHIP OR TRUST(if none,write N/A): See Attached. _ OJ Page 1 of 5 -�� �1-E249167DBCB7 Page1 of6 i 1E249187DBCB7 I ,III ,I III DocuSign Envelope ID:0208D2FD-B487-48E7-8A96-C952C8CDAC95 III. ISSUE TO BE LOBBIED: Describe with as much detail as is practical, including but not limited to a specific description where applicable of a pending request for proposal,invitation to bid,or public hearing number. Development Approvals&Planning Issues,including but not limited to the Historic Preservation Board, Design Review Board,Planning Board,Board of Adjustment,Land Use Development, City Commission, and any City Workshops or Committees,if necessary,relating to the property located at 550 Washington Avenue in Miami Beach,Florida. IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(a)(4), list the City Commissioner or City personnel sought to be lobbied, and whether the lobbyist has entered into any contractual relationship (paid or unpaid) with said City Commissioner or City personnel from 12 months preceding such commencement of service with the City to the present date,stating the general nature of the subject contractual relationship. Full Name of Individual and Contractual Relationship(If yes, explain) : YES NO Title of Person to be Lobbied Staff for the Planning& Building Department None X Public Works&City Administration,PB,HPB,BOA None X DRB, City Commission, and Mayor as necessary 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. List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an appearance of impropriety(if none,write NIA): None ti U V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note that a contingency fee is prohibited pursuant to City Code Sec.2-485.3): $675:00 per hour Page 2 of 5 Doc ID:39664F23-6720-4648-8FE74E249187D8C67 I Paget of I 2E249187D8C87 I ,III �'_,J 'I II I +ti www.dccvdocverify.cam DocuSign Envelope ID:0208D2FD-B48748E7-8A96-C952C8CDAC95 The following six(6)questions MUST be answered: 1) Pursuant to Ci ty Code Section 2-488,entitled Prohibited Campaign Contrihutims By I-ohhyists On Procurement Issues": _Yes xNo: Are you lobbyingon a present or pending bid for goods. equipment orservices. or on a present or pending award for goods.equipment or service? 2) Pursuant to City Coda Section 2-490,entitled'Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes xNo: Are you lobbying on a pending application for a Development Agreement with the City or application for change of zoning map designation or change to the City's Future Land Use Map? 3) Pursuant to City Code Section 2-482(h), any person (except those exempt from the definition of'lobbyist" as set forth in Section 2-481)whoonly 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 city clerk as requiredby this section, but shall not he required to pay any registration fees. _Yes XNo: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement? 4) Pursuant to City Code Section 2-481, the term "lobbyist" specifically excludes the following persons: Expert witnesses who provide only scientific,technical or other specialized information or testimony in public meetings;any person who only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance,whether direct, indirect or contingent,to express support of or opposition to any item;and any person who only appears as a representative of not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for the appearance. Yes X No: Are you providing only scientific. technical or other specialized information: appearing as a representative of a neighborhood association without special compensation or reimbursement or representing a not-for-profit based organization for the purpose of requesting a grant without special compensation or reimbursement? 5) Pursuant to City Code Section 2-481(1), no campaign consultant shall lobby the City Commission for a period of 12 months following the swearing in of any elected official(s)for whom the campaign consultant provided campaign consulting services within the past election cycle.See Section 2-491 for more information. Yes xNo: Have you provided campaign consulting services to an incumbent member of the City Commission within the past election cycle?If yes, please list the incumbent member(s)of the City Commission: Yes x No: k • 1 "•`;`t `i set n•.>'121 months,since'thwelected&ofhcial s hwhomi..t u rcvi , : :s i i s'. .i Itin`pie voicesw areiiri7, 6) Pursuant to City Code Section 2-482(a)(4)a., a lobbyist who has within the past election cycle provided campaign consulting services to an Incumbent member of the City Commission (which lobbying activityis not otherwise prohibited by Code section 2-491) shall disclose such particular service on hislher lobbyist registration form and shall orally disclose such particular 04 service beforelobbying the City Commission ata public meeting. c _Yes XNo: Have you provided campaign consulting services to an incumbent member of the City Commission within the past election cede?If yes,please list the incumbent member(s)of the City Commission; Yes xNo: Iftves v e eli u promised ora•did2you rq eyetec po n -cansiderq Iaffn egchanA`i' fnra alnkatgp1 consullln_g servilces7 TO BE COMPLETED BY CITY CLERK'S STAFF/ONLY t(. Annual Registration fee: [ )Yes ki No Amount Paid$ •���r1 MCR# �( `v �C' l Dat Pald 7-k-7.-� 7 Lobbyist Registration Form received and verified by= — i=' S• -o~—; r•.\ONR\SALL\i9ouMn\LOMYIEJTFORMa\Lobb;rirARegialtaliunFolmRNaiac:J 09-20-):a REGdJc, Revised 09120/2018. m Page 3 of 5 D.w.dofy ID:39684F23-6120-4858-8FE1•E249187DBCB7 Page 3 of 6 I 3E249187D8C67 -,III GTCr�.QnSi.�,I II wmcdowerify.com _ VI. SIGNATURES UNDER OATH: ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO EXPENDITURE OR COMPENSATION DURING THE REPORTING PERIOD.' Signature of Lobbyist: Date I do solemnly swear or affirm that all of the foregoing facts, statements, and disclosures in this form are true and correct, and that I have read or am familiar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: L,rj Date Signature of Principal: Date (ellt(9° VII. NOTARY SIGNATURE AND S:IAL: LOBBYIST: PRINCIPAL State of State of or G�Gi County of: County of: N,t I r Qu(L', Sworn to(or affirmed)and subscribed before me Sworriito(or affirmedand subscribed before r17 g this dayof ,20 by this L'( dayof -�V Michael W. Larkin IA' MUM NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _Pr duced ID A FORM OF IDENI1FICATION Fr OF IDENTIFICATION X Personally Known _Personal) `I • \‘ Signature of Notary Public Signature of Notary Public �U 1 Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped (NOTARY SEAL) (NOTARY SEALS _os'"'° DIANARAMOS MY COMMISSION#GG 308355 l EXPIRES:April 10,2023 : F;°Q`;;;V Bonded Thru Notary Public Underwrir�s ,' ' The term "lobbyist'specifically excludes the following persons: Expert witnesses who provide only scientific, technical or other specialized information or testimony in public meetings;any person who only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance, whether direct, indirect or contingent, to express support of or opposition to any item; and any person who only appears as a representative of not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for the appearance. Page 4 of 5 , i • DocuSign Envelope ID:0208D2FD-B487-48E7-8A96-C952C8CDAC95 VI: ".SIGNATURES UNDER OATH: . . . . . - ON-FEBRUARY 28 OF EACH YEAR. EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A • SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL .AS COMPENSA ION ..RECEIVED:-FOR THE PRECEDING CALENDAR YEAR 11y1TH REGARQ TQ THE SPECIFIC ISSUE ON WHICH THE LOBBYIST HAS-BEEN ENGAGED TO LOBBY: A STATEMENT-SHALL-BE FILED_ EVEN IF THERE HAS BEEN NO • EXPENDITURE OR COMPENSATIO[ URING THF REPORP TfNG ERIQ[2,` . Sgrlatua r of I ritlhytsl - f)Ie do sciimnfy,ii it ui at1rt111 that all rlt rill lohri)piurf lads, slalerrti'rlts and ili'.i hxiuures it thm torn are. Imre Qaildi Collect. - . . and Ihat.1 havc rgad.or am famIar with the provlsions contained iri Ctiaptor 2. Art. VII, Derision 3. onttticd 'Labbyl.:' ref .. the IbfiarniBoActi CsiI•?'t:cxde Arid nil IPf1'IAlingr'efllrrern ll!i - - - - Srgnallsof Lobbyist. e: Date _. .. . __ 1 . - I . . . • . Siipialreion pl. . jA nate _ t . , _P . . . • . • c__.„__; , ,' .. . . . • • . • - . . . . • • . .- VII. .NOTARY SIGNATURE AND S Ak_ •i • . . LOBBYIST: PRINCIPAL. . j . . "Starr r f . . • f1 ,- State of` Or i t`(i . . • Coian1 of : j . County Of Na11:k-IAf c).,?(1-C • . Swain to(or 01176.e:fly cd b and subscnbefore'me , . Swer a or affrmie and subscr ]ed before . . this.. dav of : : ._,2U.. ,14!i °Otis t li.day r1. - ., 1f ei .._.___.:2Q— y: . . Michael 1,W. Larkind1 t,J1 I� %� . . 1AVE of L_ieflw 'SAI'..r„. ...i. r:I'A'_ . . . . I'l ixlur+411 ILD. _ - . J�f'rprit�,ecl Ifs I t r1 . ttr d7 Cit alyt \ P'' r r °f;Flw 1;;1-,-d; . X, Pcrsonaily.Known `- Peft'i nalli� ' <+t.1_, • - • • Srgnattsa of Notary I\iblu.-. . tirrfnaItue ref Notary',lhrtllrr;. ”: Narile of Notary. T';pod;Printed er Stampoli . Nano of Notirr', Typed,Printed ix Stamped (NO f Af V�t il.? (NOT,ARY SEAL e4r,N+6ttnwX; yy,.••� I�'a GJ44441S.,3,.'13:ism o:r . ; -"ate, ' F1:PIfiES.Ar il10,2-V,'.3 . E-,--lei.1?e,p4 ti.',Pilo+:utLialanr* • ''The tEnn'lobbyist'sperifir� �r e iriudes the.'fr-rtlrr.%'m q f rrsnns: . • . .Expert;,itrresses who.picduidy only•Scigrltirff;technical or otherLcialiccd lrint:lunation ex'ilestliuuii,in public Irtt lin gs:any-pergel.;s.4So . . . only appo Irs as a reixeseniafrre of a neighborhood assor_iation:wilhalrt coaiiptnsation cc rcirnburseintnl kr the appearance:, whether F it�i ;indirect or contingent.to press.sup(:,or1 ot.er cpposmnadi 1,_,arty item:,ind onyr'prrsnn:•1ho only af,pr-.rrs�ic._ri reprevi16 s-nta e F. ' .enrol-fur-profil:ccmmunit1based arganiaatian ftc the purpose of requesting a grant vitoiyt special cernpenseniau_cc icirribursemerli kg L,', . . the appLar ante. • - • . pagti4of5 . . . a . a 0 . • • F3 . • m I.DocVerity ID:39664F23-8120.4648 8FE7-E249167DBCB7 I Page 4 of 6 I 4E249187D6CB7 I •ai a_ a7 F E1 III .1 www.docverify:com , — .___�__ _;;1, =lI— ' DocuSign Envelope ID:0208D2FD-B487-48E7-8A96-C952C8CDAC95 • VI. SIGNATURES UNDER OATH: ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES. AS WELL AS COMPENSATION RECEIVED, FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO EXPENDITURE OR COMPENSATION DURING THE REPORTING PERIOD.1 DocuSigned by: Signature of Lobbyist Date 6/22/2020 • 39112R355119F6410 • I do solemnly swear or affirm that all of file foregoing facts, statements, anddisclosures in this form are true and correct, • and that I have read or am familiar with the provisions contained in Chapter 2,Art VII, Division 3, entitled"Lobbyists" of the Miami Beach City Code asig„ „fing requirements. Signature of Lobbyist: .- >-- JJ Date 6/22/2020 3 d10 Signature of Principal: 7R ,idA - Date X1111131171 dr VII. NOTARY SIGNATURE AND S:AL: LOBBYIST: PRINCIPAL • State of Florida State of • County of Miami-Dade County of: Swornto(or affirmed)and subscribed before me Sworn to(or affirmed) and subscribed before me this 2 day of June ,2020,by this—day of ,20_,by Michael W.Larkin NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _Produced ID FORM OF IDEN11 Fl CATION FORM OF IDENTIFICATION x Personally.Known Personally Known • tit-- Signature of SignatureNotary re of Public 4. csl Diana Ramos N omPr£1119VaQii,S.mf.d„Achill Lucia 17.tautnp1j Name of Notary, Typed, Printed or Stamped 58 ♦Diana Ramos R Commission.#GG 308355 N 1 Notary Public-State of Flcrida ► (NOTARY SEAL) ,; 4-Nly Commission Expires Apr 10,2023 1 u I 4 N 1 The term"lobbyist"specifically excludes the following persons: a, I Expert witnesses who provide only scientific, technical or other specialized information or testimony in public meetings;any person who - only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance, whether direct, indirect or contingent, to express support of or opposition to any item;and any person who only appears as a representative of not-for-profit community based organization for the purpose of requesting a grant without special corrrpensaiiun or reimbursement for N the appearance. Li Page 4 of 5 DocVerify rif 3986.4F23-8120.4648-BFEt-E249167DBC®7 Page5 of6- 1 5E249167D6CB7 ,III 1I III _ www.d ocreriry.cern 4 DocuSign Envelope ID:0208D2FD-B487-48E7-8A96-C952C8CDAC95 INA I dV CBEA 4 City of Mami iseacn, onvennon center unve,Miami Beach,Florida 33139,www.miarnibeachfl.gov • Office of the City C erk Rafael E.Granada,City Cler< CityClerk@mic7mibeachfl.gov Tel: 05.673.7411. Fax:305.673.7254 NAME OF LOBBYIST: Michael W. Larkin 1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT Pursuant to City Code Section 2-485(d), the City Clerk shall notify any lobbyist (or principal)who fails to file timely a Lobbyist.Fee Expenditure and Compensation Statement (Statement). In addition to any other penalties that may be imposed as provided in Section 2-485.1, a fine of $50.00 a day shall be assessed for Statements 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 of each year, 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. I hereby acknowledge that on February 28 of each year, I shall submit to the City Clerk a signed Statement under oath listing all lobbyist expenditures, as well as compensation received, for the preceding calendar year with regard to the specific issue on which I have been engaged to lobby. 2) LOBBYIST WITHDRAWAL Once an issue I have registered to lobby has concluded or I am no longer lobbying on that issue, I shall immediately file a Notice of Withdrawal with the Office of the City Clerk. 3) ANNUAL LOBBYIST REGISTRATION FEE N, I understand annual registration of all lobbyists shall be required for each 12-month period commencing October 1 of each year, and the fee for such annual registration shall be $500.00 pursuant to Section-2-482 of the Miami Beach City Code. DocuSigned by: U " � 6/22/2020 37R21435511gF6410 Signature of Lobbyist Date LL rD o F:ICLERISALLIeFORMS1LO88YIST FORMS1Lobbyist Regloiratim Form Revised 09.20.18 REG.doc N Page 5 of 5 DocVerify ID:www.docverlfy.com III64F23-6120-4648-BFE7-E249187DBCB7 I page 6 of 6 I 6E2491B7D8CB7 • , nIuI III .`I EXHIBIT B 550 Landlord, LLC • Massa Investment Group, LLC(100%) o Mathieu Massa (100%) • S . A F docIerify33 MWL - Lobbyist Form - fully executed.pdf DocVerify•I D: 3966AF23-B 120-4648-8FE 1-E249187D8CB7 Created: June 22, 2020 11:14:26 -8:00 Pages: 6 Electronic Notary: Yes/ State: FL This document is a DocVerify VeriVaulted protected version of the document named above.It was created by a notary or on the behalf of a notary,and it is also a DocVerify E-Sign document,which means this document was created for the purpcses of Electraiic Signatures and/or • Electronic Notary. Tampered or altered documents can be easily verified and validated with the DocVerify veriCheck system. Go to www.docverifv.com at any time to verify or validate the authenticity and integrity of this or any other DocVerify VeriVaulted document. .1 • E-Signature Summary E-Signature 1:Michael Wayne Larkin(MWL) June 22,2020 11:15:54-8:00[86212D04E7A5][38.86.132.251] mlarkin@brzoninglaw.com(Principal) E-Signature Notary:Diana Ramos(dra) + June 22,2020 11:15:54-8:00[9A189D249146][38.86.132.251] dramcs©brzoninglaw.corn r 11111 I,Diana Ramcs,did witness the participants named above electronicallysign this document 111111111111111I11111111111111111111111111111111111111111111111111 11111111111111111111111111 111111 IIII 11111 11111 11111 IIII 11111 1111 1111 • DocVerify documents cannot be altered or tampered with in any way cnce they are protected by the DocVerify VeriVault System.Best viewed with Adobe Reader or Adobe Acrobat. All visible electronic signatures contained in this document are symbolic representations of the persons signature,and not intended to be an accurate depiction of the persons actual signature as defined by various Acts and/or Laws. DocVerify ID: www.docverify.can 3966AF23-6120-4848-8FE7-E249787D8C67 w ,III li'•E'S.iTli�CCiiiaaa �I III 'Generated Cer Pagel E2491 B7DBC87 Miscellaneous Cash,Receipt CITY OF MIAMIBEACH No 0 Cash 0 Credit Card �v Check# ` r.- e. , , 00 �; I • � J7 b 20I Rived of .° k K, A J 1.1 0,- " r.., Miscellaneous-‘1 eti- 402© Atcylsslik , . �,. i �"-"� d Y t "` Y++#'«. rr') ` `r '� ;4t m a 9 a•.'� t .:,i� ..�. 1 ;' I Ft` R OPEN } r � � Payment Pmeunt: : 1,400.00 a 42(O4 (THIS INFORMATION MUST BE COMPLETED) ,Office of Finance Director 3 Accountuin-ben"` "$` �xva, � � « /d. ,, 1r `;:1 : .. 4.. [ Pre arer: t Dept EXT: r ,.