Michael W. Larkin/ Alan Waserstein~~ 7Z4/~ 1Z2~~ /229 ('ol~inrJ
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:
Alan Waserstein
NAME OF PRINCIPAL/CLIENT:
12`h and COllins Real Estate, LLC 6001 NW 153 Street, Suite 110 Miami Lakes Florida 33014
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 827-8373 wasrco@aol.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: Alan Waserstein
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: Alan Waserstein
II. SPECIFIC LOBBY ISSUE:
HPB and BOA Extension of Time Applications in Connection with Redevelopment of 1201, 1225, and 1229 Collins Avenue
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 Dept., BOA, HPB, 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.
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FIAT RATE OR OTHERf
A) LOBBYIST DISCLOSURE: (Required) $ 375.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 375.00 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 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 man 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 compensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST 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. _
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are t
familiar with the provisions contained in Se ion ~82 of
requirements.
Signature of Lobbyist:
and correct and that I have read or am
Mianmi Beach City Code a d all re orting
I
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION:
Produced ID
Form of Identification
Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn to and subscribed before me
This day of , 20_
Signature of Public Notary -State of Florida
Notarization of Lobbyist's signature
Produced ID
Form of Identification
Personally known (Prin ~m;~,,,, TERESALMARQUES
~ • MY COMMISSION N DD 653705
~:J~A= EXPIRES: April 3, 2011
'1~",~~----~~~_--_rt0.0.0.0.0.0.,~~~^^^~~''______ Bonded Thru Notary Public Underwfltels
State of Florida, County o -
Swor and subscrib d b fore me
This day of ~7 , 20~q
Signature of Public Notary -State of Florida
Notarization of Principal's signature
FOR CLERK' USE ONLY /
Annual Registration fee: [ ]Yes [ ] No Amount Paid MCR #~D( Date Paid ~ a
Lobbyist Registration Form received and verified by: Entered By:
F:\CLER\$ALL\MARIA-M\LObbyist\LOBBYIST fORM OS.doc Revised 12/08/04
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Gity of Miami Swch, 170(} Convention Tenter Drive, Miom`s Seoch, FSoricta 33139, www.miomibeochfl.gov
Ctrl' CLERK Q~Flce
7e1; 305.673.741 1 ,Fax: 345.673.7254
C4tyCEerk~miami6eacP~fl.gov
LOBBYIST NAME: M ~ C~4,Zt L-0~.~ ~~ ~
I understand that na later thou October i st of each yeatr, I must file the following
farms, pursuant to Section 2-4$S of tfle Miami Seach City Code, with the City Clerk's
office far all active lobbying issues.
] ~ Lobbyist Expenditure Farm
2j 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 far cads violotian evaluation.
In addition, once an issue I have registered to lobby on has been resolved, I om required
to immediately notify the City Clerk's Office of lobbyist withdrawal in writing.
i6~9~0~
Signature: Date: