Michael W. Larkin - Mike Sullivan AMMEACH ,
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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.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:
Mike Sullivan
NAME OF PRINCIPAL/CLIENT:
Gap Inc. 1 Harrison Street San Francisco FL 94105
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State). (Zip Code)
(415)427-6708
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)]
to NAME OF CHIEF OFFICER, PARTNER,OR BENEFICIARY:
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IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
z A 3 � SPECIFIC LOBBY ISSUE: '
R
v`v U velopment approvals—1001 Lincoln Road
ue to be lobbied(Describe in detail):
CITY AGENCIES/INDMDUALS TO BE LOBBIED:
Full Name of Individual/Title B)Any Fina6cial,Familial or Professional Relationship
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HPB, BOA None
Planning Department staff None o-s'•
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City administration,elected officials None Q L-jj
*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 OTHERr
A) LOBBYIST DISCLOSURE: (Required) $ 445.00 oer hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (Required). $ 445.00 oer 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,eguipment 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 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
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD.
Signature of Lobbyist
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I do solemnly swear that all of the foregoing facts are true and correct and that I have read or a
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reportin %$ o �•,
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requirements. was
Signature of Lobbyist: W
Signature of Principal/Client: G,i I �w C,• 9€ I .
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: Cool
❑ Produced ID ��Df� Oroduced ID G`Dl_ ' A-]12-1
Form of Identificatio � Form of Identification
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c-personally known (Lobbyist) ❑ Personally known (Principal)
VII. SIGNATURE AND STAMP OF NOTA 1� Q
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State of Florida, County of Miami-Dade o RL State of-Heri4a, County of Miami-Bad
Sworn to and subscribed before me U o N s Sworn and subscribed before me
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This_ _day of 20VA This day of �(Y\r�. , 20 2
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Sig'natu're of Public Nota State o Florida Signature of Public Notary-State offloiida--Cat r�� �-
Notarization of Lobbyist s signature Notarization of Principal's signature
FOR CLERK'S USE ONLY /
Annual Registration fee: [ ]Yes[ ]No Amount Paid MCR Date P d
Lobbyist Registration Form received and verified by: Entered By:
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST fORM 05.doc Revised 12/08/04
F:\CLEI listration Form.doc Revised 04/27/2012
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City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granada, City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.741 1 , Fax: 305.673.7254
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LOBBYIST INANE:
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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 falls 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 Public Trust
Signature: Date:
C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc