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Michael W. Larkin (2)m MIAMIBEACH 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., Suite 850 Miami Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 377-6231 (305) 377-6222 mlarkin@brzoninQlaw.com TELEPHONE NUMBER: FAX NUMBER: EMAIL: I. LOBBYIST RETAINED BY: Seth Gadinsky NAME OF PRINCIPAL/CLIENT: 1680 Michigan Avenue. Suite 1001 Miami Beach Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (786) 276-2387 (305) 675-7759 Seth@Gadinskvrealestate.com TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional) Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)] • NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: II. SPECIFIC LOBBY ISSUE: Extension of Time for Development Approvals for 2000 Normandy Drive Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title ~ B) Any Financial, Familial or Professional Relationship Planning and Zoning Department Staff, DRB, BOA, City Commission * None * Unless an issue is legislative In nature, DRB, BOA, Planning are not lobbied outside of a public hearing setting. y~~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR OTHERf A) LOBBYIST DISCLOSURE: (Required) ~ 385 00 Der hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 385 00 Der 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 lobbving on a Wresent or Wending bid for goods eauinment or services or on a present or pending award for goods eauinment 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 lobbving on a Wending aWWlication for a Development Agreement with the Citv or application for change of zoning map designation or change to the Citv's Future Land Use Man? 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 comg_ensation gr 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 RECENED, 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. _ /t s ~ ~ SignaturE of Lobdyist I do solemnly swear that all of the foregoing familiar with the provisions contained in Sectio requirements. Signature of Lobbyist: Signature of Principal/C VI. LOBBYIST IDENTIFICATION: ^ Produced ID ~, ~ ~ Form of Identification Personally known (Lobbyist) .- VII. GNATURE AND STAMP OF NOTARY: $r ~~ ~ ~. sd~' State o Swom This orida, County f mi-Dade a subsc~tb f me day of 20 Signature of Public No - St a of Florida Notarization of Lobbyist's signature PRINCIPAL IDENTIFICATION: ^ Produced ID Form of Identification personally known (Principal) ~`~11N19iNilt%a;;; ~~~e.2o,~%N.. ~. :~ •*` ••• * ~ 6862 ~ Q #OD • ~ . State of Florida, County of Miami-Dade //~~~'~i~Bj~I~~-liipl~'`~',~ Sworn and subscribed before me This ZQ o day of ~~'~+-~, 20 a y Signature of Public Notary -State of Florida Notarization of Principal's signature FOR CLERK'S U E ONLY - Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR # Date Pai Lobbyist Registration Form received and verified by: Entered By: L F:\CLER\~ALL\MARIA-M\LObbyist\LOBBYIST FORM OS.dac Revised 12/08/04 facts are true and correct and that I have read or am n 2-482 of the Miami Beach City Code and all reporting ~„ .., 4 city of Miami Beach, T 700 Convention Center Drive, Miami Bloch, Florida 33 T 39, www.miamibeo~h#l.gov CIiY CIERK C?~Fica Tel: 345_b73,74 T T ,Fax: 305.b73.7254 C ifyClerk~m+orrtit3eachft.gov LOBBYIST NAME: ~! G~ ~ 8~ yyr L~~~/! I understand that no later than Oc#ober 1st of .each year, I must file the following forms, pursuant to Section 2-485 of the Miami $each City Code, with the City Clerk's Clffice for all active lobbying issues. 1 ~ Lobbyist Expenditure Form 2~ L~15ClOSUre Form Failure to file these forms on a timely basis will result in my name being transmitted to the Jvliami-Dade County Commission on Ethics and far 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. ~ ~a o Signature: ate. _.':-~~