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Michael W. Larkin - Philippe Harari (2) MIAMI BEACH 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 South Biscayne Blvd., Suite 850 Florida 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)374-5300 1305)377-6222 mlarkin(a�brzoninalaw.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: Philippe Harari NAME OF PRINCIPAUCLIENT: 15 Palm Aqua,LLC 411 Michigan Ave Mami Beach Florida 33139 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305)283-5151 aauabluedesian('a-)amail.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:Philippe Harari • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST:Philippe Harari II.SPECIFIC LOBBY ISSUE: Development board approvals for the Propertu located at 15 Palm Avenue. Issue to be lobbied(Describe in detail): Ili.CITY AGENCIESIINDIVID'ALS'=T0 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 Contractual Relationship(Explain) YES FX O title of person to be lobbied Planning Department and Building Department Staff None X B, HPB, BOA, FP, City Commission, LUDO, and None Commission Committees, 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. ec 2-482 Any Financial,Familial or Professional Relationship None None , � - None C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.0utlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc Z1 r 11a M1 7 IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $475 per hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $475 per hour (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 lobbvina on a present or oendina bid for goo ds.eauinment or services,or on a present or oendina award for aoods.eauinment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes X No: Are you lobbvina on a pendina application for a Development Aareement with the City or application fQE change of zoning map desianabon or chanae 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 X No: Are you representina 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 = 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 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: Signature of Principal/Client: VI. IDENTIFICATION: b IDENTIFICATION: privV47W IS 10 C�?0_ _Produced ID a ,� Produced ID Form of Identification ° `° Form of Identification Q G C Z , Personally known(Lobbyist) � 'L .y Personally known(Principal) , z a E — e VII. SIGNATURE AND STAMP OF NOTARY: o E L „�,•••� av � Mate of Florida, County of Miami- ade z State of Florida, County of Miami-Dade Sworn to a subscribe Mbefo r a .•��«+' �o''%� Sworn^d subscri ed before ; This day f 13 ;; $y:1�? This day f _ 2013 01 . 9th 3 ��181141 ' v m 0 of — e of Florida Sig rrizaPtion lic Notary—State of Florida "ia otarization signature No Prin=signature 4 i TO RE COMPLETED AY C ITY C,Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# ate P C:AUsers\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc � •"• BETTY UBMI A t MY C0M✓4 NI0N II DD 060413 EXPIKS:Us*6,2014 ;ft to Banded Thru Notary Public undartAniters F:\CLE 'istration,Form.doc Revised 04/27/2012. .. /V\1, B E A(A40.q** City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139, www.miamibeachfl.gov CITY CLERK Office Rafael E.Granado, City Clerk CityClerk @miamibeachfl.gov Tel: 305.673.7411 ,Fax: 305.673.7254 LOBBYIST NAME: Michael W. Larkin 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 r - 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: Date: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc