Michael W. Larkin - Dr. Leonard Hochstein -
M
. . � '
� / B EA ~�� ^ 8�
City of Miami Beach Office of the City Clerk
1700 Convention Center [)rive. Miami Beaoh, FL 33138 `~
LOBBYIST REGISTRATION FORM
| Lobbyist means all persons employed or retained, whether paid or not, by principal who seeks to encourage the paaoage, defeat or
modification of any nndinonun, oeao|udion, action or decision of any commissioner- any actiun, deuiainn, recommendation of the
City Manager or any city board or committee; or any oction, decision or eoommendaiion of any city personnel during the time period
of the entire decision-making process on such oction, decision or recommendation that funnoeeob|ywill be heard or reviewed by
the city commission, or a city board or committee. The term opadfioaUy includes the principal as well no any employee engaged in
lobbying activities. The term "Lobbyiom»" has specific exclusions. Please refer b»Ordinance 2OO4'343S.
| Larkin Michael W.
NAME OF LOBBYIST: (Last) (First) (M.1)
Bercow R d U & Fernandez, PA 200 South Biscayne Blvd., Suite 850 F| hd 33131
BUSINESS NAME AND ADDRESS ' ' (City) (State) (Zip '
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office iy your contact information changes:address,phone, mr e-mail address.
|. LOBBYIST RETAINED BY:
`
Oc Leonard Hochot»in
NAIIE OF- PKINUIPAUGLIEN 1:
� 1047 North View Drive W1|om| Beach Florida 33140
BUSINESS NAIVE AND ADDRESS (Number and Street) - (City) (State) (Zip Code)
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:
�
(305) 931-3338 (305� 931-3324 Ihochstein@aol.com
x.SPECIFIC LOBBY ISSUE:
Developmental Board Approvals for 42 Star
issue to be lobbied(Describe in detaily
III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant u,City Code Section u-4u2(m)(4) include the commissioner o,personnel sought u,uo lobbied,and whether the lobbyist has entered
into any contractual ,n|ounnomp (nom or unpaid) with said uuv commissioner or nommnno| from 12 months preceding such
person's
commencement of service with u` i the date,stating the |nature or the subject contractual relationship.
Sec 2-482(a)(4) Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to be lobbied
Commission, Planning Staff, Development Boards 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
. :___-$._-_ __-_-_- . —. . Registration
�~ v
\
7 \
i /\|| |
�/ .
IV. DISCLOSURE OF TERMS AND AMOUNTS OF L.OBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY, FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE: (Required)$
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPE ATION):
(Required). $ Ll 3.5-
/ r
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 Mry Ara you lobbying on a present or Wending bid for goods, eauipment or services.or on a present or pending
award for goods,eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues"-
Yes K1^.Are you lobbying on a pending application for a Development Agreement with the City or application
fu 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 Are you rei2reseang a not-for-profol
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
F_QB THE PRECEDING CALENDAR YEAR, A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR COMPENSATION DURING JJJE REPORTIN
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 reporting requirements.
Signature of Lobbyist:
9 _
r
Signature of Principal/Client: GG
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID Q Produced ID
Form of Identification fi°.y,A. Form of Identification ovs•wo,
Personally known (Lobbyist) _X•0 m Personally known
(Principal)VII. ` s,,.',��� r��y.ary i'ur,iic s►Orz or Fiorid;,, 'A g SIGNATURE AND STAMP OF x q
i 17'
NOTARY: f` �', ':1; C ocnmission EE032_:.4 o m 5' m
04/10/2015 er m A 3 m v
State of Florida, Counfy of Miami`wade"` °{'` State of Florida, County of Miami-Dade o m N
Sworn subscribpo before me Swor subsc ibed befp re me cn 0 0
This �rcq day of , 2012 This "day o .Q`ft , 2012 N T
d
Signatu re of Public Notary—State of Florida Sign1it6re of Public otary—State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ No Amount Paid$ J �® M C R# I /T OA n Dat id
Lobbyist Registration Form received and verified by:
F x 3 t B EAC r� i1 � 'a.F �iy x 1-1
City of N iami Reach, 1 700 Convention Centcr Drive, Miami Beach. Florida 33139.NvNNw.miamibeachll.gov
CITY CLERK Office Cit%Clerki?miamibeachfl.gov
Tel: 305.673.7411 , Fax: 305.673.7254
LOBBYIST NAME: Michael W. Larkin
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.
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 Public Trust.
- �
Signature: Vate:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc