Michael Larkin 2228 Park Avenue MIAMIBEACH
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City of Miami Beach Office of the City Clerk RECTA/Fr)
1700 Convention Center Drive, Miami Beach, FL 3 h1J 9IJV _4
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LOBBYIST REGISTRATION FORM
CITY r CL L .YS OFF `r
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:
2228 Park Avenue, LLC, contact: Todd Glaser, Managing Member
NAME OF PRINCIPAL/CLIENT:
2228 Park Avenue, LLC P.O. Box 402249 Miami Beach Florida 33140
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786) 208 -2113 (305) 538 -4302 tmgeng64 @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: Todd Glaser, Managing Member
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: See Exhibit A
II. SPECIFIC LOBBY ISSUE:
Development approvals for conversion of two 4 -story townhouses to a restaurant and entertainment establishment located at 2228
Park 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 Department Staff, HPB, BOA, Planning Board and
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.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
■
A) LOBBYIST DISCLOSURE: (Required) $ 425.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 425.00 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 ":
r. Yes X No: Are vou 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 ":
LJYes X No: Are vou 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 a not - 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..
1 Yes X No: Are you representing a not - 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 COM N ION DURING THE
REPORTING PERIOD.
Signature o 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 e Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist: / �,
Signature of Principal /Client:
VI. LOBBYIST IDENTIFICATI j ..___
PRINCIPAL IDENTIFICATION: ` -�
Produced ID Produced ID «yw DAVID SOLOMOII
• ' Notary Public • State of Florida
Form of Identification Form of Identr ',_ ' Comm. Expiry Aug 10, 2011
N 4 Commission * DO 967266
o�
,C Personally known (Lobbyist) Personally known (PrincipalN ' ` Bonded Through National Notary Assn
Q N o
fl N 4 z ` VII. SIGNATURE AND STAMP OF NOTARY:
F n- Ea o n- State of Florida, County of Miami -Dade State of Florida, County of Miami -Dade
2 W Sworn to and subscribed before me Sworn and subscribed before me
This a� day of C1cl'0e,'BP�, 20 to This 2, day of Abu/ 0
-.:,,, 7 , i S of Publ Nota reil r ida Signature of Public Notary ` fi t' . • sa
---- -7,,i Notarization of Lobbyist's signature Notarization of Princip. lY- signature
FOR CLERK'S USE ONLY p
Annual Registration fee: [ ] Yes o Amount Paid .. . e'er / / / * a I
A M / # Date Paid
Lobbyist Registration Form receiv a nd verified by: �T / Entered By:
F: \CLER \$ALL \MARIA -M \ Lobbyist \LOBBYIST fORM 05.doc Revised 12/08/04
Exhibit A
Disclosure of Interest
2228 Park Avenue, LLC
c/o Todd Glaser, Managing Member
P.O. Box 402249
Miami Beach, Florida 33140
OWNERSHIP ENTITY % OF STOCK
1. Mitchell Rubinson & Edda Rubinson, tenants by the entireties 50
3525 Flamingo Drive, Miami Beach, FL 33140
2. The Glaser Children Irrevocable Trust (2/2/2005) 50
3681 Flamingo Drive, Miami Beach, FL 33140
Trustees: Kim Glaser & Todd Glaser
Beneficiaries: Levi Cole Glaser
Chloe Pearl Glaser
Stone David Glaser
Coral Sky Glaser
Total 100
J
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk @miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
Acknowledgement of fines /suspension from lobbying for failure to
comply with City of Miami Beach lobbying Laws
LOBBYIST NAME: A't (CI&qe ( , * 1 � jJU* Y
rebethit-A e S, aggt6 °F aAtk yam -
I understand that no later than -o eoeh- -ye 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 special 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 -DADE 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 WITHDRAWAL IN WRITING.
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Signature: Date:
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