Michael W. Larkin - Jose Carlos Ponte „s, AA! A ,-, A ..,_, yr '
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City of Miami Beach Office of the City Clerk `, •
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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:
Jose Carlos Ponte
NAME OF PRINCIPAL /CLIENT:
370 -380 S. Hibiscus Drive Miami Beach FL 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305 - 372 -9216
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:
Board of Adjustment Application
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
Board of Adjustment Members
None
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* Unless an issue is legislative in nature, HPB, BOA, Planning Board, and City Commission members r(ob t a public hearing setting.
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Iv. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) S435.00 per hour ._
F3) PRINCIPAL'S Disci OSURE (OF LOBBYIST COMPENSATION): (Required). $435.00 per hour_
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
, i Yes X No: Are ou lobb i . on a present or pending bid for goosis, eguipment 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":
__Xes X No: Are ou lobb in on a sendin. a .lication for a Devlo . ent , . reem- nt with th - City_or
pplication for change of zoning map designation or charige_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 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,.
f i Yes X No: Are you representing a not-for-profit corporation or entity without special compensation
or reimbursement.
v. SIGNATURE UNDER OATH:
ON OCTOBER l 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 COMP T DURING THE
REPORTING PERIOD.
Signature of Lob yist
1 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 f Miami Beach City Code and all reporting
requirements.
Signature of Lobbyist:
_.---- ..
Signature of Principal/Client: ,------ __,---?------- ------
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VI. LOBBYIST IDENTIFICATIbM--- PRINCIPAL IDENTIFICATION:
. „
i Produced ID Xroduced ID t) L_..
Form of Identification Form of Identification
Personally known (Lobbyist) L Personally known (Principal)
_ :- VII. SIGNATURE AND STAMP OF NOTARY:
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State of Flodda, County of Nliami-Dade State of Florida, County of Miami-Dade
....-. 4 , Sworn • - nd subscrib before me Sworn ..g before ine
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This "litk- ay of 2011 This 4=ay ofx ,,t... 177011
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., •4 i . otary - State of Florida Signatur: • 8 ray - State of Florida
Notariz- T of Lobbyist's signature Notar ation incipars signature
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FOR CLERK'S USE ONLY //A .,
Annual Registration fee: [ ] Yes [ - I No Amount Paid 5 so,- MCR #--'/ i Date Pai r A 8 , /./ . •11 1
7:34 op , 1 , 1
Lobbyist Registration Form received and verified by: __ Entered By:
. .
1 N .W.,;^ , FACIEMIALL \MARIA ;4\ Lobbyist\LOBBYIST fORM 05 dot *. . Rerised 12/08/04
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33 i 39, www.miamibeachff.9ov
CITY CLERK Office CityClerkCmiomilbeachfl.aov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: MICHAEL W . LARKIN
1 understand that no later than February 28th of each year, [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 yist 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.
Signature: Date: