Michael W. Larkin - Irving E. MillerCity of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
2Q(2 MAR 27 PH 1: 18
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encoCrriaigd td_pa'ss'ege, (defed('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.
NAME OF LOBBYIST:
Larkin
(Last)
Michael
W.
(First)
Bercow Radell & Fernandez, PA 200 South Biscayne Blvd., Suite 850 Florida
BUSINESS NAME AND ADDRESS
(305) 374-5300
TELEPHONE NUMBER:
(Number and Street) (City)
(305) 377 -6222
FAX NUMBER:
(State)
33131
(Zip Code)
mlarkin(c�brzoningiaw.com
EMAIL:
Please notify this office if your contact information changes: address, phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Irving E. Miller
NAME OF PRINCIPAL /CLIENT:
2305 Lake Avenue Miami Beach Florida 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786) 208 -2113 Tmgeng64Ca�aol.com
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:
Lot Split and Design Approval for Propert y at 2305 Lake Avenue
Issue to be lobbied (Describe in detail):
ul. CITY AGENCIES /INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2- 482(a)(4) include the commissioner or personnel sought to be lobbied, and whether the lobbyist has entered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months preceding such
person's commencement of service with the city to the present date, stating the general nature of the subject contractual relationship.
Sec 2- 482(a)(4) Full Name of Individual and
title of person to be lobbied
Contractual Relationship (Explain)
YES
NO
�c ter`. iL
.�
Pursuant to City Code Section 2- 482(g) Every registrant shall be required to state the extent of any business, financial, familial or professional
relationship, or other relationship giving rise to an appearance of an impropriety, with any current city commissioner or city personnel who is
sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2- 482(g) Any Financial, Familial or Professional Relationship
F : \CLER \$ALL \aFORMS \LOBBYIST FORMS\Lobbyist Registration Form.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE: (Required) $445.00
4-1L1
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
(Required). $445.00
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists On Procurement
Iss
€ Yes
2) Pursuant to Miami Beach City Code 2 -490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate
lopment Issues ":
Are you Iobbvina on a present or pending bid for goods. eauipment or services. or on a present or pending
award for aoods. eauipment or service?
€Yes t No Are you Iobbvina on a pendina application for a Development Aareement with the City or application for
chanae of zoning map designation or chanae 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
;tem, shall register with the clerk as required by this section but, shall not be required to pay any registration fees.
€ Yes
Are you representina a not- for - profit corporation or entity without special compensation or reimbursement. .
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th 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 o e foregoing facts are true and correct and that I have read or am familiar with the provisions contained
in Section 2 -482 of the Miami Bt�ach City Code and and all reporting requirements.
//
C
" • Signature of Lobbyist: /!�' /�'
Signature of Principal /Client:
VI. LOBBYIST IDENTIFICATION:
€ Produced ID
Form of Identification
€ Personally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami -Dade
Sworn lo a�d subscribed before me
This y day of ikiktprOfk 201
1 Wt. ?4n1-k)_S
Signature of Public Notary — State of Florida
Notarization of Lobbyist's signature
-///14i//\._
PRINCIPAL IDENTIFICATION:
€ Produced ID
Form of Identification
€ Personally known (Principal)
State of Florida, County of Miami -Dade
Sworn� avid subscr b fore me
This L I day of !�� U , 201g
(\)A tkYli7( Vix 1(11W
Signature of Public Notary — State of Florida
Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ] Yes No Amount Paid $ MCR
Lobbyist Registration Form receiNed and verified by:
Date Paid
F: \CLER \$ALL \aFORMS \LOBBYIST FORMS\Lobbyist Registration Form.doc
orra. d oc
Revised 1/ 11 / 201 1
City of Miami Beach, 1700 Convention Center Drive, Miami )?each, Florida 33139, www.miamibeachil.gov
CITY CLERK Office
Tel: 305.673.7411 , Fax: 305.673.7254
CityClerk@niamib ea all.gov
LOBBYISTNAME: M 1 t/16k eI (' -� C�
I understand that no later than February 28th of each year, I must file the following
fluid, pursuant to Section 2485 of the Mani 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 h as been resolved, I ani required
to immediately notify the City C le rk's 0 ffice of lobbyist withdrawal in writing.
Pursuant to Section 2 -485 (d), the City Clerk shall notify any lobbyist (or principal) who fails to
timely file a Statement and in addition to any other penalties which may be imposed as
provided in Section 2- 485.1, a fine of $50.00 a day shall be assessed for all Statement(s)
filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on
Ethics and Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the
assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 3 0th, 2012, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
Signature:
F: \CLER \$ALL \aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
3)aC a60-
Date: