Michael W. Larkin - Bais Menachem, Inc.m MIAMIBEACH
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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 -obbying 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 mlarkinCa~brzoninglaw com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Bais Menachem, Inc., contact: Joseph (Yosie) Lipskar
NAME OF PRINCIPAL/CLIENT:
Bais Menachem. Inc. 444 West 40th Street Miami Beach Florida 33140
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)672-5055 (305)534-0336
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: Zalman Fellig, President
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: Bais Menachem, Inc., is a Florida Non Profit Corporation
II. SPECIFIC LOBBY ISSUE:
Ordinance for creation of 40th Street Overlay Zoning District
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship
Planning Department Staff, City Manager and Staff, Planning
Board and City Commission*
None
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y~~~au.~ ~~~ i~a~u~c, nannury cuaru anu uty wrr1rm55iOn mefTlDerS are n0L IOD~1~ D~ai~lp2~rof'a pupik~h~~ing setting.
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]N. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERr
A) LOBBYIST DISCLOSURE: (Required) $ 425.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). ~ 425.00 Der hour I
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":
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 may 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 CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECE]NED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR~OMPENSATION DURING THE
REPORTING PERIOD. w~ ~ n
Signatufe'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 Rrii~cipal/Client:
VI. LOBBYIST IDENTIFICATI
PRINCIPAL IDENTIFICATION:
^ Produced ID
Form of Identification
N g PI Personally known (Lobbyist)
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~ VII. SIGNATURE AND STAMP OF NOTARY:
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ff ~ W State of Florida, County of Miami-Dade
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~ worn to and subscribed before me
This day of f~~G~ ST, 20~~p
~• Signature of Public Notary - tate Florid
Notarization of Lobbyist's signature
^ Produced ID
Form of Identification
C~ersonally known (Principal)
State of Florida, County of Miami-Dade
Sworn subscribed before~me
This day of I'. V a~.\ ~n f v
Signature of Public . -State of Florida
Notarization of Pr cipal's signature
FOR CLERK'S U E ONLY y~~
Annual Registration fee: [ ]Yes [ ] No Amount P 3~ ~ CR # 3~,/ 9,
Lobbyist Registration Form received and verified by: Entered By: ~
F:\CLER\~ALL\MARIA-M\LObbylst\LOBBYISr FORM OS.dot
Paid ( .
Revised Y2/08/04
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk@miamibeacfifl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
Acknowledgement of fines/suspension from lobbying for failure to
comply with City of Miami Beach lobbying Laws..
•LOBBYIST NAME: I " ~~ ~~``~ W_ ~' ~l /l
I understand that no later than October 1st of each year, lobbyists subject to lobbyist
registration requirements -shall submit to the city clerk a signed statement under, oath
listing all lobbying expenditures, as. well as compensation received; for the preceding
calendar year with regard to the specific issue on which the lobbyist has been engaged
to lobby... A statement shall be filed even if there have been no expenditures. or
compensation during the reporting period.. The statement shall list, in detail, each
expenditure by category, including .food and beverage, entertainment, research,
communication, media advertising, publications, travel, lodging and specicl events.
FAILURE TO TIMELY -FILE THE EXPENDITURE AND FEE DISCLOSURE REPORT
WILL RESULT IN A FINE OF $50.00 PER DAY. ANY LOBBYIST WHO FAILS
TO FILE THE REQUIRED EXPENDITURE REPORT BY DECEMBER 1, SHALL
AUTOMATICALLY BE SUSPENDED FROM LOBBYING ..:UNTIL ;ALL FINES :ARE
PAID, UNLESS THE .FINE HAS BEEN APPEALED TO THE. MIAMI-DADS COUNTY
COMMISSION ON ETHICS AND PUBLIC TRUST. In the event a lobbyist fails to
either file the report and/or pay the assessed fines, the Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust.
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 WITHDRAWA4 IN WRITING.
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Signature: Date: