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Michael Larkin/Yaakov and Roza HalmovCity of Miami Beach Office of the City Clerk 1700 Convention Center Drive, Miami Beach, FL 33139 LOBBYIST REGISTRATION FORM Lobbyist means ali persons employed or retained, whether paid or not, by a principal who seeks bo encourage the passage, defeat or modification of any ordinance, resolution, adios or derision of any commissioner; any action, derision, recommendation of the City Manager or any dty board or oommitbee; or any action, derision or recommendation of any aty personnel during the time period of the entire dedsbn-rnaldng process on such action, decision or recommendation that foresee.~ly wiN be heard or reviewed by the dty carWnission, or a dty board or committee. The term specifically lndudes the prir~cipai as wel! a5 any employee engiage+d in lobbying activities. The term "Lobbyists" has speciAc exdustons. Please r+el~er to Ordinance 2004-335. Larkin Ml~rael W. NAME OF LOBBYIST: (Last) (First) (M•n Bercow, Radell A Fernandez P.A. 33131 BUSINESS NAME AND ADDRESS (Zp Code) (305) 377-6231 TELEPHONE NUMBER: 200 South Biscayne Blvd., Suite: 850 (Number and Street) (Gty) (305) 377-6222 FAX NUMBER: Miami, Florida (~~) mlarkin@brzoninglaw.com EMAIL:' I. LOBBYIST RETAINED BY: Yaakov and Roza Haimov NAME OF PRINCIPAL/CLIENT: 3757 Prairie Avenue Mimi Beach Florida X139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (~P Code) (305) 216-6457 TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fib out this section if primal is a Corpa short, Partners~r ar Tn~st [Section 2-482 (c)] •1 NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: •2 IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE O'NMERSFiIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Design Review Approval from the Design Review Board yj Z 5 `~ P ~,~„ r Issue m be bbbied (Describe in detail): III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: A) Fu6 Name of Irrdividual/7itle B) Anil , Fandtfai a Professional ~ 9 ~. ~. ~Y Commission None IV. DLRCL06URE OF TERNS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER MOiURL Y RAT RAifE DiR Ofl/ERJe; A) LOBBYIST DISCLOSURE: (Required) ~ 375.00 oer hour B) PRINCIPAL"5 DISCLOSURE (OF LOBBYIST COMPENSATION): (Required)._,.~ 375.00 i~ hour The folMvirinB information must be answered: 1) Pursuant to Miami Beach City Code Section 2-4$8 F~titled "Prohibited Campaign Contributions By Lobbyists Cm Procurement Issues": © Yes X No: Are You lobbvina on a waaaett or Q~ng bid for eauioment or services. or yea w~esent or award for g~r4SiJ or service? 2) Pursuant do Miami Beach Gty Code 2-490 Entitled "Prohibi6ed Campagn Contributions By Lobbyists Cln Real Estate Development Issues": Fttes X No: Are you lobb~g on a aaulication for a Deem nve~o a t Agreement witfi tfie City or sgglication for d>tanae of:oon~i ,8 mau designation or chanee to the Citv's Future j,~,a,nd use Maoa 3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of "bbbyist" as set forth in Section 2-481 above) who only appears as a representative of a not-for- profit corporation or entity without special oompensatior~ or reimbursement for the appearance, whether direct, or indirect, to express support of or opposition b~ any item, shah register with the clerk as required by this section but, shall not be required to pay any registration fees.. V. SIGNATURE UNDER OATH: oN ocroeER i~ of EACH YEAR, EACH LOBBYIST SHALL SUBMiT TO THE CLTY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS DOMPENSATION RECEIVED, IN THE CITY OF MIAMI BEAM! FOR THE PRECEDING GLENDAR YEAR. A STATEMENT SHALL BE FIti.ED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPOR?ING PERIOD. /~J lure of Lot~yist I do solemny swear that all of the foregoing fads 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 requiremerrts. Signature of Lobbyist: Signature of Prinapal/C~ient: vI. LossYlsr IDENiIFIGTION: ~ Produced ID Form of Identification 0 Personally known (Lobbyist) ~I~o~ Vii,:«~~~?.tr!~_ 0 Produced ID Form of Identfication ly known (Principal) VII. SIGNATURE AND STAMP OF NOTARY: ~..~L/'l/~I/`^' - .. *P~Bi~~ LUCIA J.MORAGA ' * MY COMMISSION # DO 526512 * EXPIRES: March 8, 2010 ~TA~OF F`O~`QQ Bonded Thm Budget Notary Services ~~ o LL. Of o ~_°o ~. ~.Q M L ~ ~ 1 °S'c ~Eom 5~U n Z ~ ~ w State of ,County Miami-Dade S bsa'i This day of 2~' ablic Notary(f State of Florida of Lobbyist's signature State ~ Florida, County ~ Miami-Dade Swom and sut-scrit~d before me~~ Y P ~~ J, ~~ COMMISSION ~ DD 526512 1~~••u „ EXPIRES: March 8, 2010 ,wry = ru NaWr lemvka ndpal's signature ~~Oa S ~M . of r Sigl~ature of Publl Nlo#arization of FOR t~ERK'S ONLY ~~! f-/~ Anna ~ i tion fee: [ „ Yes [ ] No Amount Paid ~~~_ MCR # ~ Date Paid Registration Form received and verified by: Entered By: F:\CLER\S~\M~'M~Y~\LOBBYIST FORM OS.doc RM9ed 12/08/04