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
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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:
George Crosby
NAME OF PRINCIPAL/CLIENT:
5473 N. Bay Road Miami Beach Florida 33140
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 539-4705
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
II 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:
Variance Approval for the Property Located at 5473 N. Bay Road
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/Title I B) Any Financial, Familial or Professional Relationship
Dept., BOA, HPB, Planning Board, City Commission I None
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
r FLAT RATE DR OTHERf
A) LOBBYIST DISCLOSURE: (Required) $ 425.00 -per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). 425.00 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":
pYes X No• Ar~you lobbying on a present or en nding bid for aoods eauinment or services or on a
present or nendina award for aoods, eauinment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
[LYes X No• Are you lobbving on a Wending application for a Develoument 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..
1LYes 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. `~R /
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V ~/
Signature f 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. ^, _ _ n
Signature of Lobbyist:
Signature of Principal/Client:
VI. L088YIST
^ Produced ID
Form of Identification Form of Identification
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PRINCIPAL IDENTIFICATION:
_ ~ ~ Produced ID
`~ 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
!7Personally known (Principal)
State of Florida, County of Miami-Dade
Swor ~ subscribed efore me
This day of +~ , 20
Signature of Public Notary -State
Notarization of Principal's sign
MY COMMISSION # DD 634106
~v°,oES: May 26, 2011
Bonded Thnr Notary Public lkiderwrilers
[ ] FOR CLER ~E ONLY 2i~
Annual Registration fee: [ ]Yes No Amount Paid Q MCR #,7f/~ Date Paid
Lobbyist Registration Form received and verified by: fl n . ~ntered By:
F:\CLER\$ALL\MARIA-M\LObbyist\LOBBYIST fORM OS.doc t • ~ ~ ~ ~ ~ Revised 12/08/04