Michael W. Larkin - Jill Menzel � R+
MIAMIBEACH
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 spedfic exclusions.
Please refer to Ordinance 2004 -3435.
Larkin Michael W.
NAME OF LOBBYIST: (Last) (First) (MI)
Bertow Radell & Fernandez, P.A. 200 South Biscayne Blvd. Suite 850 Miami FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) all) Coe)
305 - 377 -6231 305- 377-6222 MLarldnpBRiallrgLetv.care
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office If your contact Information changes: address, phone, ore -mall address.
I. LOBBYIST RETAINED BY: •
Jill Menzel /�t!1 (- i MENZL=1
NAME OF PRINCIPAL/CLIENT:
49 Palm Avenue Miami Beach FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (ZO) Code)
•
305-588 -1616 ,•
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:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
•
II. SPECIFIC LOBBY ISSUE:
Historic preservation and design review approval.
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2- 482(a)(4) indude the commissioner of personnel sought to be lobbied, and whether the lobbyist
has entered into contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding
such person's commencement of service with the city to the present date, stating the general nature of the subject contractual
relationship.
Sec 2482(a)(4) Full Name of individual and Contractual Relationship (Explain) YES NO
title of person to be lobbied
William Cary & planning staff, HPB, ORB, City N � x
Commission 0 'S: N131 � , t,1 i 3
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Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extent of any business, financial, familial or
professional relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner
or city personnel who is sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2- 482(g) Any Financial, Familial or Professional Relationship
1
None.
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL y FLAT4I TE OR OTHER)
A) LOBBYIST DISCLOSURE: (Required) 5435 per hour
8) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $435 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 ":
0 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 R+l Estate
Development Issues ":
oYes X No; Are you lobbying on a pending a for Agreement with the City application
or ni a d i ?
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..
0 Yes X No: Are you repjenting a not- for - profit corporation or entity without special compensation or
reimbursement. .
V. - SIGNATURE UNDER OATH:
• F_..U, : m • , I _A• . ,..:13 0_ 1A . •T1 IS 1
UNDER OATH. LISTING LOMB �
PENDITURES. AS WELL AS COMPENSATION RECEIVED. IN THE CITY OF
MIAMI BEACH FOR THE PR . ffi ALENPAR YEAR. A STATEMENT SHALL B FILED EVEN IF THERE HAVE BEEN
•E.P D 1ESO' •u'1 r•t • • , It _ • '•'TI • -: •► /
V
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts are true and correct and that 1 ve read or am familiar with the
provisions contained in Section 2-482 of the Miami Beach City Code and II in irements.
'
Signature of Lobbyist:
Signature of Principal /Client: irc7, 7 . /t
VI. LOBBYIST IDENTIFICATION: P IDENTIFICATION:
_i Produced ID Produced ID R. /t- / Say 7 s4 y ._ S 5 —0
Form of Identification Form of Identification
r i .. -,6 _ - a i frersonaiiy known (Lobbyist) Personally known (Prindpal)
•,. • SIGNATURE AND STAMP OF NOTARY:
f 1 .0xr n„ Notary Public State of Florida
`f • to of Florida, County of Miami -Dade State of Florida, County of Miami-Di ° ,- ¢ Ana Hernandez
'., . m t• - nd subsc ' • - . before me Sworn and sub-.; • - • before me '` My Commission 00668383
o i is ~ = •y t. ! 20�[ This day • Y ?' For • Ex•ires04 /29120.1 �_
ffi •
' i '62; 1 447' i l /
1
, •', .ture •" otary — State of Florida Signa re of • • is Notary State 1, 1, da
„' tie 1 i tariza 'of Lobbyist's signature Notari - :•n of Prindpal's signatur:
�� r F FOR CLERK'S USE ONL /
s 1 .i -- i ual Registration fee: ( ] Yes [ ] No Amount Paid 3 5� MCR # D 0 q y O / • ' . to Paid •
_ •byist Registration Form received and verified by: f , i Entered By: , _ Am l gairr
Revised 1/11/2011
1A/v\1BEAC1-1
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miomibeachfi.gov
CITY CLERK Office CityClerk @miomibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: /11 / c t ) `'p LefC
1 understand that no later than October 1st of each year, 1 must file the following
forms, pursuant to Section 2 -485 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
1) Lobbyist Expenditure Form
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 on Ethics and for code violation evaluation.
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.
9 acl 14/?
Signature: D e:
F :ICLERILOBBYISTILobbyist Registration Form 32708.doc