Michael W. Larkin - Russell Galbut J 1
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City of Miami Beach Officerof the;City,Clerk
_ 1700 Convention Center Drive,`.Miami Beach, FL 33139. :.
'...,.• , _ LOBBYIST REGISTRATION FORM:• S
_ Lobbyist means all persons employed or retained, whether paid or not by a principal Who'seeksito.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;acton, decision or recommendation of any city personnel during the time
period of the entire decision-making pr ocessdnsuch:ettion,decision or recommendation that foreseeablywill 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 20043435: _
a. Larkin .. Michael _ : , , W - __' -
NAME OF LOBBYIST: '(Last): (First), " , . (M.I) -
Bercow,Radell&Fernandez,RA _ •200 S:Biscayne Blvd.,.Suite 850 Miami, Florida 33131 ' v
N:. . . Street)r -c'' (City) 1 :. (State) (Zip Code) _
BUSINESS NAME AND ADDRESS (Number and
(305)377-6231 (305)377-6222 mlarkin @brzoningl'aw.com '
TELEPHONE NUMBER: ,-.'.: `FAXTNUMBER: - ' ;I EMAIL .
1:
� I. LOBBYIST RETAINED BY
Russell Galbut I h
NAME•OF PRINCIPAL/CLIENT:,,.; `
4
BUSINEancial,LLC -' 2-2'
200 Blscavne;Blvd. Miami ,i. ;Florida 33137
REG'Finan NAME AND'ADDRESS (Number and Street) (City)' -_
•,(State) .• _ (Ziry Code) -
(305)573-4127. , ', , ._ ;,, . )(305)573 78489 _ f
TELEPHONE NUMBER: FAX NUMBER:(Optional) ','EMAIL.,(Optional)
Fill out this°section'if principal is aiCorporation,Partnership orTnist'(Section 2-482: c
• NAME OF CHIEF"OFFICER,:PARTNER„IOR BENEFICIARY: ”
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY`.OR INDIRECTLY,A 5%OR MORE;OWNERSHIP INTEREST'IN`,SUCH - ,
CORPORATION,PARTNERSHIP OR:TRUST. ,1:- 1'
r
,II.' , SPECIFIC;LOBBY ISSUE:
Development Board Reviews,for 1690'Collins Avenue and 1685 James,Avenue, ;.
Issue to be lobbied(Describe in detail);: =' I '°
III. CITY AGENCIES/INDM DUALS'TO BE LO BBIED
', '-,,, A)Full Name of Individual/Title B)Any;Financial,Familial or Professional Relat ons�
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BOA,DRB,HPB,aStaff None I m n ,'—)
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None cry K m-1.1 6-
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*Unless an Issue Is legislativelininature,'EIPB;BOA,PlanningiBoard,and city Commisslommembersiare ot,lobbled outside of'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) $ 435.00
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (Required). $ 435.00
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 man 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 1ST 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
'344a,, SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
m 3 o z REPORTING PERIOD.
0 112 a
3 -0 Signature Lobbyist
g o Co I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
0 N m
&%1.1,1 o familiar with the provisions contained in Section 2-482 of the Mi. i Beach City Code and all reporting
requirements.
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Signature of Lobbyist:
Signature of Principal/Client:
LOBBYIST IDENTIFICATION: rv� PRINCIPAL IDENTIFICATION:
•
+,s•NOS ❑ Produced ID S .�•NO ❑Produced ID
o F� Form of Identificati Form of Identification
£ Personally known (Lobbyist) ^' Personally known (Principal)
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a o m Z VII. SIGNATURE AND STAMP OF NOTARY:
0 v • ;,z;; �Br DAYAMI AGUIAR
t 3 . �,1 `= wary Public-State of Florida
is l s State of Florida,County of Miami-Dade t State of Florida,Coun Df P e, Comm.Expires Mar 'S.2015
Y.° "' Sworn d subscrib be or me Sworn .Id subscr''ed 77'=
This da of C 201/ s This A •y of �4 �j Commission # EE 70292
Viitig\t( �
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Signature of Public Notary—State of Florida ° Si natur=o is Nota ' State of Florida
9 rY 9
Notarization of Lobbyist's signature Notari ion•f Principal's signature
Annual Registration fee: ]Yes[ ]No Arno 4• Paid RK'S U. ONLCR#B I _I eL Date Paid 101 I 30/1)
Lobbyist Registration Form received and verified J. . Ihr Entered By:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc �: Revised 12/08/04
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City of Miami`aeach; 1700'Convention Censer Drive,Miami Beach,Florida 33 i39,w, •ve.rniamioeochfi.gov
CITY CLERYOffice CityClerl:CmiamioeacFfl.gov
Tel:305.673.74 1 1 ,Fag:305:6737254
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LOBBYIST NAME: MICHAEL W. LARKIN
I understand that no later than February 28th of each year, 1 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.
„47/116/1\ YIY d
Signature: Date:
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