Michael Larkin/1600 Lenox Investors, LLC Greenstreet Partners, LPr e vc~ Lis ~c /eve
M I AN11 BEAD H ~~e``~~° ~~v~
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 brzoninglaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
1600 Lenox Investors, LLC c/o Greenstreet Partners, L.P
NAME OF PRINCIPAL/CLIENT:
2601 South Bavshore Drive, Suite 800 Miami Florida 33133
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 858-4225 (305) 858-2334
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: Jeffrey Safchik, President
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: ~ ,C ~~ ~.
II. SPECIFIC LOBBY ISSUE:
Historic Designation, revocable permit, flood plain variance and redevelopment issues concerning 1600 Lenox Avenue
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title
Planning and Zoning Department Staff, HPB, BOA, City
Commission
B) Any Financial, Familial or Professional Relationship
None
unless an issue is legislative in nature, HPB, BUA, Planning Board, and City Commission members are not lobbied outside of a public hearing setting.
~~~
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERf
,~~o,,
A) LOBBYIST DISCLOSURE: (Required) .00 er hour
D}~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSA ON): (Required). $385 00 per hour
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~~_
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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 present or cending bid for goods equipment or services, or on a
present or pending award for goods equipment 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 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
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 comuensation
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
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.
~~
gnature 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
requirements. ,„ ~ ~ r / ~
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
/ Form ofIde
/~ Personally known (Lobbyist)
VII.
State of
Sworn ~
This /~4
TORE AND STAMP OF NOTARY:
Countyp~,l~(iam
~ ature of Public Notary - State of fFlelr
~`~• s~ Notarization of Lobbyist's signature
FOR CLER ' USE ONLY f } ,[
Annual Registration fee: [ ]Yes [ ] No Am Paid ~ MCR #a` ~~~~ Date Paid .J
Lobbyist Registration Form received and verified A ~ Entered By:
F:\CLER\$ALL\MARIA-M\LObbyist\LOBBYIST fORM OS.doc Revised 12/06/04
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Principal)
NOTARY' PUBL3~-S~A'fE np FI:ORIDA
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State of Florida, County of Miami-Da Expires: Al.::, (il, X009
Sworn and subscribed before me Bonded Ttu-u Atlannc Bonding Co., Inc.
This Z~~iay of a..2 , 20~
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Signature Pu c Notary -State of Florida
Notarization of Principal's signature
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City of Miami Beath, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office
Tel: 305.673.7411 ,Fax: 305.673.7254
CityClerk@miamibeachfl.gov
LOBBYIST NAME: ~~/n ' ` ~ " ~ ~~~~
I understand that no later than October 1st of each year, I must file the following
forms, 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 Form
2) Disclosure 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, I am required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
l/V ~~
Signature:
~3~u~ Q
Date:
F:ICLER\LOBBYISTtLobbyist Registration Form 32708.doc
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Organlzat3on Chart - 1600 Lenox Investors LLC
Steven J. Green -
i00% shareholder
Jeffrey A. Safchfk -
PresidentfTre asu rer/
Secretary
1
"Genera! Partner"
Greenstreet Management, Inc
{Delaware Corporation)
1%
"Llmlted Partners"
Greenstreet Capital, LP - 32.00%
Knowledge Industries. LLC- 67 00%
99%
MG Real Estate Partners, L P
(Delaware Limited Partnership)
1 100%/Sole Member
Greenstreet SaBE Envestments.
LLC
(Delaware Limited Liability
Company)
i00%15o1e Member
1600 Lenox Investors. LLC
(Delaware Limited Liability
Company)
Property