Larkin, Michaelm M!AMIBEACH
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 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:
John Kunkel
NAME OF PRINCIPAL/CLIENT:
1398 Bav Drive Miami Beach FL 33141
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 586-3148 kunkelja@bellsouth.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:
C~ N
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN S'~CH c°-,
CORPORATION, PARTNERSHIP OR TRUST: -C A
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II. SPECIFIC LOBBY ISSUE: W
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Variance Approval for 1398 Bay Drive ~~ __'
Issue to be lobbied (Describe in detail): O ''
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III. CITY AGENCIES/INDMDUALS TO BE LOBBIED: ~ `_T? C'`~
A) Full Name of Individual/Title I B) Any Financial, Familial or Professional Relationship
Planning Department, BOA, 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.
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERr
A) LOBBYIST DISCLOSURE: (Required) $ 385.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). 385.00 per 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 pending bid for goods equipment or services or on a
present or eu nding 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 loblzYing on a vending application for a Development Agreement with the Citv or
application for change of zoning map designation or change to the Citv's Future Land Use
Map?
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 CIiY 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.
Signature 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. `~`~
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
~ Form of Identification
o o ~ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
~ ~ _ ~ State of Florida, County of Miami-Dade
z ~~ w Sworn to nd subscri_b efore me
~c.•mo~ ?This da 20,~
a~ t
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~~' ~ Signat a of P o - S ate o lorida
Notar atio ob yist's signature
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PRINCIPAL IDENTIFICATION: 0 _O
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~roduced ID ~ • ~
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Form of Identification ~ ~
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^ Personally known (Principal) ~•,~
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State of Florida, County of Miami-Dade ~`
Sworn and subscribed before me
This 1~day of , 20
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Signature of P c ~ ate of Florida
Notarizatior~of ipal's signature
•/ FOR CLERK'S U E ONLY c (~< D / < ~f
Annual Registration fee: [ ]Yes [ ] No Amount Paid _~~~ MCR #~ /~O ( Da e Paid v
Lobbyist Registration Form received and verified by: Entered By:
F:\CLER\jALL\MARIA-M\Lobbyfst\LOBBYISTfORM OS.doc ReWsed 12J08/04
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City of Miami Bench, 17D4 Convention Center Drive, Miami Bench. Florida 33139, www.miamibeochR.ga+r
CITY CLERK C~~Ice CityCterk~m=amibenchfl.gav
Tel: 34S.b73.741 I ,Fax: 345.b73.7254
L08BYl53 NAME: r' l t C.h ~.~. ~ L c~ I+c. i ~
I understand that no la#er than 4tt#obet 1 s# of each ~ec31r, I must file the following
forms, pursuant to Section 2-4$5 of the Miami Beach City Code, with the Ci#y Clerk's
C>fFice far all acfiive labbying issues.
1) lobbyist Expenditure Forrn
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 an Ethics and for code violation evaluation.
(n addition, once an issue I have registered to lobby on has been resolved, ! am required
to immediately notify the G#y Clerk's C>ffice of lobbyist withdrawal in writing.
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Signature: Date: