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Michael Larkin/304-312 Ocean Drive, LLCm MIAMBEACH 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 Ordnance 2004-3435. Larkin Michael W. NAME OF LOBBYIST: (Last) (First) (M.I) Bercow, Radell & Fernandez P.A. 200 South Biscayne Blvd., Suite: 850 Miami, Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 377-6231 (305) 377-6222 mlarkin@brzoninglaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: 304-312 Ocean Drive, LLC NAME OF PRINCIPAL/CLIENT: 600 North 3rd Street, 2nd Floor Philadelphia PA 19123 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (215) 625-9722 (215) 625-0167 louisjorocofskvl@earthlink.net TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Phillip McFillin, Louis Orocofsky • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Phillip McFillin II. SPECIFIC LOBBY ISSUE: Redevelopment of 304-312 Ocean Drive - COA, Variance Approvals, and Conditional Use Permit Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship Planning Dept., HPB, BOA, Planning Board, City Commission * None * Unless an issue is legislative in nature, HPB, BOA, Planning Board, and City Commission members are not lobbied outside of a public hearing setting. .J ~~ 1V. Ul,t,LU~UKtVt ItKM,A1VUAMVUIY1~UrLVtStfYlJ1 ~.VMYCIV,AIIVIV (U1~~:LVJC WI'tCIrItKHUUKLf, FLAT RATE OR OTHERr ., ,n A) LOBBYIST DISCLOSURE: (Required) $ 385.00 Der hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 385.00 oer hour 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 Wending bid for goods equipment or services or on a present or Wending award for goods, eauipment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": ^Yes X No• Are you lobbying on a Wending application for a Develog_ment Agreement with the Citv or aMp~Wnlication for change of zoning mawdesignation or change to the Citv's Future Land Use ' '~' CAL 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 anot-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 No• Are you representing anot-for-profit corporation or entity without special compensation or reimbursement. . V. SIGNATURE UNDER OATH: ON OCTOBER 1~ 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 FOR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD. ;~/'/f'! /~' Signature of Lobbyist ~ ^ Produced ID . Form of Identification . ~ ~ Personally known (Lobbyist) _ ~', VII. SIGNATURE AND STAMP OF NOTARY: ~'~ State of Flor' u ami-Dad ~ Swor crib r ~,~, ~ Th' ay o Sig ur ublic Notary - to of orida tarization of Lobbyist's signature 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 requirements. _ , ^ „ ,, , Signature of Lobbyist: Signature of Principal/Client: LOBBYIST IDENTIFICATION: ~ V ~'~ PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification .~ Personally known (Principal) :~ is s. State of Florid uof Mi mi-Da e g Swory~~d s r e~y~meM~p Public Notary - Statebf Florida n of Principal's signature FOR CLERK'S USE ONLY ~1~,~~~ Annual Registration fee: [ ]Yes [ ] No Amount Paid _,~~ MCR # ~"l Lobbyist Registration Form received and verified by: Entered By: F:\CLER\BALL\MARIA-M\Lobbyist\LOBBYIS~' fORM OS.da ...7 ~°~ ~ Paid Revised 12/08/04