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Michael W. Larkin - JP Morgan Chase and Co. (Chase Bank) tS: MA MBEACH ei/ e;4-1 atf qo/ City of Miami Beach Office of the City Clerk p 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 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: JP Morgan Chase and Co. (Chase Bank) NAME OF PRINCIPAL /CLIENT: 4 New York Plaza, 19 Floor New York NY 10004 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 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: Teresa Torres • IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: Publicly Traded Company o -Z 77 II. SPECIFIC LOBBY ISSUE: r--- " t design approvals for 6901 Collins Avenue; TC regulations; TC Design Guidelines W Issue to be lobbied (Describe in detail): (... z=. < C�t III. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED: CO A) Full Name of Individual /Title B) Any Financial, Familial or Professional Relationship Planning Department Staff, DRB *, 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. 57 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 ": n 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 ": 11Yes X No: Are you 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 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 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.. n 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 COMPENSATION DURING THE REPORTING PERIOD. Signatur /7/1 obby 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 .1 i Beach City Code and all reporting requirements. Signature of Lobbyist: ignature of Principal /Client: ��. ./ A1` ..r / ' / o a) I. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: t R.44: al in • w Produced ID Produced ID • co c g N Form of Identification Form of Identification N m .y mciz ; o m ' Personally known (Lobbyist) 'personally known (Principal) d .5 C V • o ev,,a 0 z ° 2 w II. SIGNATURE AND STAMP OF NOTARY: o »• ,ma • rib _ �, �» ,1 'tate of Florida, County of Miami -Dade State of Florida, County of Miami -Dade o 0 o worn �Q and subscribe�,p� fore me l' Sworn and subscribed before me ( " • � * Yr �L(y s his day of I , 20 This .2 day of , 20 1 a — D / W - 4 ' D\CAt\CA - ZOVI P Signature of Public Notary — State of Florida Signature of Public Notary — State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature FOR CLE 'S SE ONLY p Annual Registration fee: [ ] Yes [ ] No Amount Paid MCR # iIf D.te Paid // Lobbyist Registration Form received and verified by: c 7 ' 4/154,5 Y 9 y: Entered By: ��,� F: \CLER \$ALL \MARIA -M \Lobbyist \LOBBYIST fORM 05.doc Revised 12/08/04 • ' « c •l. .. lava+ �+I .�n"awa,,, 4 City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachff.gov CITY CLERK Office CifyClerk@)miarnibeachfl.gov Tel: 305.673.7411 , Fax: 305.673.7254 LOBBYIST NAME: /4 I understand that no later than February 28th of each year, I must file the following form, 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 and Compensation 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. S Signature: Dat -: