Michael Larkin - Isaac Urztein trIk MIAMIBEACH f°
g
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 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 @brzonlnglaw com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Isaac Ursztein
NAME OF PRINCIPAL /CLIENT:
Roshtov 909, LLC 2875 NE 191 Street Aventura Florida 33180
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786) 338 -1774
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:
Roshtov 909, LLC - 909 Collins Avenue Property
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
kPI� 4 Al o ;� stli
Pion/1'i n s-/-0+{: AJ JJIJJO S, 4 31J A11I0
Wd L- i ioz
* Unless an issue is legislative in nature, HPB, BOA, Planning Board, and City Commission members are not lobbied outside cO pl \hea tyfg .1
, - IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) P 35.00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required 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 ":
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 ":
Yes 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..
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.
Signature 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 S -ction 2- 82 of the Miami Beach City Code and all reporting
requirements.
S
4/Atir '
ignature of Lobbyist:
Signature of Principal /Client: / i VI. L INTFICATON: ' r 2 ro/ Fof Identification ''' O *_ Form of Identification
Pe rsonally known Lobbyist) 4., Personally known (Principal)
m
VII. SIGNATURE AND STAMP OF NOTAR'. X•o g�
3
a 3 17 c
State of Florida, County of Miami -Dade N g State of Florida, County of iitti
Sworn t94nd subscribed % before o w 0 Sworn d subscribe" befo , ;'• "� ° °B' - LUIS F. PINEROS it
TI da f n,Q. , 20 ' cn o s This 7- day o _ 1/14-t • Notary Public - State of Florida ,
' \ N
° ,, �yi . • My C omm. Expires Jan 13, 2013 I
\kW. L1) g a „';;o � Commission # OD 851351
Signature of Public Notary — State of Florida Signature . P blic Notary . - • • ..
Notarization of Lobbyist's signature Notarization of Principal's signature
FOR CLERK'S USE ONLY _ J
Annual Registration fee: [ ] Yes [ ] No Amount Paid MCR # J U � �
- 75 - 0 - 75 - 0 - 75 - 0 Da Paid tO 7 //
Lobbyist Registration Form received and verified by: n Enter By: '
F: \CLER \$ALL \MARIA -M \Lobbyist \LOBBYIST fORM 05.doc 4 Q� J Revised 12/08/04
tX�
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www miamibeachfi gov
CITY CLERK Office CityClerk@miamibeachfl gov
Tel 305 673.74) 1 , Fax. 305.673.7254
LOBBYIST NAME: . ( ``i C' (
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.
ignature: D e: