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Michael W. Larkin - John Taft A MIAMIBEACH s kA‘‘' 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 exdusions. 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: John Taft NAME OF PRINCIPAL/CLIENT: South Seas Hotel 1751 Collins Avenue Miami Beach Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) `it) S'S `toi '`f5 3023 J� �o� m et 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: Development approvals - 1751 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 HPB, BOA None Planning Department staff None -. ; 3 i 21 :C j C 1 1.30 110Z City administration, elected officials 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) $ 435.00 per hour B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $ 435.00 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 ": 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 PRECEDI G CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDIT S OR COMPENSATION DURING THE REPORTING PERIOD. Signature of Lobbyist I do solemnly swear that all of the foregoi, g fact - are true and correct and that I have read or am familiar with the provisions contained in : < / Ct' ,. 482 of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Signature of Principal /Client: /21/ / 3T 1 �f //)1.‘.i" VI . LOBBYIST IDENTIFICATIO : PRINCIPAL IDENTIFICATION: za `� ° Produced ID Produced ID v ! - f' ° Form of Identification Form of Identification 1/4 m ° W C o C o O N E .� Personally known (Lobbyist) Personally known (Principal) MC OZ Q cp.y � 17.g° W . % • I . SIGNATURE AND STAMP OF NOTARY: a zp� . ma c ., • .te of Florida, County of Miami -Dade State of Florida, County of Miami -Dade ° m " • orn tQ d subscribe eor Sworn a • • subscrib • -f• - - { o o • ' t ') .s ( D da f Mr V I2', 20 (( This • .y of In A / � 20 t I N at4 0 Sig ature of Public Notary — State of Florida Signature of Public Notary — State of Florida Notarization of Lobbyist's signature Notarization of Principal's signature FOR CLERK'S USE ONLY / Annual Registration fee: [ ] Yes [ ] No Amount Paid _C' MCR # ' ate Paid % l r Lobbyist Registration Form received and verified by: - Entered By: (r griry DI 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 Michael W. Larkin LOBBYIST NAME: 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. 2/ n ,./ / /// JOJ/S/ Signature: Date: