Michael Larkin - 1680 Michigan, LLC I\ 3 A Uld BEACH I - Pl_
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.1)
Bercow Radell & Fernandez, PA 200 S. Biscayne Blvd, Suite 850, Miami, FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 377-6231 (305) 377-6222 mlarkin(ftrzoninglaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
1680 Michigan. LLC—Andrea Marrocluin, Manager
NAME OF PRINCIPAUCLIENT:
Same 9858 Glades Road,#238 Boca Raton FL 33434
um er and Street) i y (State) (Zip Code)
(305) 909-4538/(305) 915-0269 (305)418-7461
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: Andrea Marroquin,Managing Member
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: Andrea Marro uin—100%
II.SPECIFIC LOBBY ISSUE:
Development awrovals and permitting issues for DroDerty located at 1680 Michigan Avenue, Unit 100, Miami Beach, FL
Issue to be lobbied(Describe in detail):
III, 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,s ting the general nature of the subject contractual relationshi .
Sec 2-482(a)(4) Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to be lobbied
Staff of Planning Department, Building Department,and Public Works None X
De artment
PB, DRB, BOA,City Commission, as necessary* None X
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
None -
�nr aio
*Unless an issue is legislative in nature,PB,DRB,BOA,&City Commission members are not lobbied outside of a public hearing setting. 1 1 A 3
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DIS(LOSE WHETHER HOURLY,FLAT RATE OR
OTHER). $�
A) LOBBYIST DISCLOSURE:(Required) I 5— C�
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (Required).
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 kddn no on a present or pmirm bid for goods,equipment or services,or on a present or
pendino award for goods,equipment or servfiae?
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 pgow no application for a Dwmkwmw*Agreement with the Cfity or application
for change of zoning map designation or ciwge to the City's Futtate Land Use Marc?
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 reimimssement for the appearance,whether direct,or indirect,to express support of or opposition to any
item,shall register with the Berk as required by this section but,shah not be required to pay any registration fees..
❑Yes X No: Are you retina a not-for-prdit corporation or eintitty witlwut special compensation or
reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28P 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 DURMS THE REPORTING PERIOD.
AC M ref W, Lek
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 contain in Section 2-482 of the Miami Beach City Code and all reporting requirements.
Signature of Lo
Signature of Principa
VI. LOBBYIST ON: PRINCIPAL IDENTIFICATION:
0 Produced ID p Produced ID
Form of Identification Form of Identification
p Personally known(L.obbybt) V-kersonailly bown(F"nd
HlEiffl lic State of Florida VII. SIGNATURE AND ST AMP OF NOTARY: gener ssion EE098763 19/2015 State of Ronda,County of Miami-Dade State of Florida,County of
Sworn to and subscribed before me Sworn MPrindpal's
This day of ,20_ Thus day
Signature of Public Notary—State of Florida of Pu Flori Notarization of Lobbyist's signature rization re
FORCLERK"S USE ONL Z
Annual Registration fee: [ ]Yes[ ]No Amount Paid Sd ' MCR� Date Paid
Lobbyist Registration Form received and verified by: S Entered By: 1 0
Revised I/11/2011
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) T�C
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): Lf( S Ar
(REQUIRED). l
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_No: Are you lobbvina on a present or aendina bid for snoods,equipment or services,or on a present or aendina
award for goods,equipment or service?
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Yes_No: Are you lobbying on a pending application for a Development Aareement 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 Section 2-482(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 No: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement.
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28 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 N 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 Section 2-482 of the Miami Beach City Code and all re orting requirements.
Signature of Lobbyist:
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
_Produced ID g _Produced ID
Form of Identification Form of Identification
m
_Personally known(Lobbyist) _Personally known(Principal)
o �
r 3•� ¢
VII. SIGNATURE AND STAMP OF NOTARY: c
ca
m
State of Florida, County of Miami-Dade `"0 g State of Florida, County of Miami-Dade
Swom t and subscribed b fore me C" Sworn and subscribed before me
This day of 12012 This day of ,2012
d
Signs a of Public No a Statf of Florida Signature of Public Notary—State of Florida
Not1rization of Lobbyist's s0gagure Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Pfd _
Lobbyist Registration Form received and verified by:
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F:�GLEI tistration Form.doc RIYINd 0+4/27/2012
MIAMIBEACH
City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granada, City Clerk CityClerk @miomibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: M(.C�ad,, W, Lqr�yn
I understand that no later than February 28 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, or I am no
longer lobbying on that issue or for that principal, I am required to immediately notify
the City Clerk's Office 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 30th, 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 Pu lic Trust.
Signature: Date:
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