Michael W. Larkin - Marc Lehmann & Jean Kim ® �C1
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City of Miami Beach Office of the City Clerk IDCk1
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, PA 200 South Biscayne Blvd., Suite 850 Florida 33131
(305) 374-5300 (305)377-6222 mlarkin brzoninglaw.com
TFI FPHQMF NI IMRFR• FAX NI IMRFR• F nAII
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
Marc Lehmann &Jean Kim
NAME OF PRINCIPAUCLIENT:
4490 North Jefferson Avenue Miami Beach Florida 33140
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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,PAK I NCR OR BENEFICrAKY. Please see attatMed EX111151tA.
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST c�
II.SPECIFIC LOBBY ISSUE:
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Development Approvals and Permitting Issues for 3591 Flamingo Drive m ry
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Issue to be lobbied(Describe in detail):
uL['_ITY AGENIf_IFIgmmnlyini JAI_S TQ RF 1 QRR1F:n-
Pursuant to City Code Section 2-482(a)(4)include the commissioner or personnel sought to be lobbied,and whether the lobti' t haantered
into any contractual relationship (paid or unpaid) with said city commissioner or personnel from 12 months poceding 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 NO
title of person to be lobbied
Planning Department and Building Department Staff None X
B, 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
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required)$475.00
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(Required)._$475.00
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Issues":
Are you lobbying on a present or new ndin0 bid for goads equipment or services or on a present ore ndina
award for goods,equipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
[] application
chime of zoning map designation or change to the City's Future Land Use Man?
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=represanting a not-for-profit corporation or antely lgithout spacial compgnsation
bursemant
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 EXPFNDITURFS OR
COMPENSATION DURING THE REPORTING PERIOD_
X
Signature of hebbyest
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. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
[]Produced ID Produced ID
Form of Identification (+:y: ,. ILERKO clIMPMENon f
MY COMMISSION#EE143406
tt/Personally known(Lobbyist) f , II�ERrnar�ap�lp2,2015
(407)398-0153 Florid U ' com
VII. SIGNATURE AND STAMP O
,':�Y°''• CRIS11NA D.GONZALE1
State of Florida, County f Miami-Dad - State of Florida,County of Miami-Dade
ty ;*: x MY COMMISSION ti DD 960888
Sworn to and subscribed b ore. a ;.. EXPIRES:March 23,2014 Sworn and subscribed before me
F� Bonded Thru Notary Public Underwriters This 2 day of
This `Z -�day of 20 p.�,�,���
Signature of Public Nota[y— tate f Flori Signature of Public Notary—State of Florida
Notarization of Lobbyist's signature Notarization of Principal's signature
/ TO BE COMPLETED BY CITY CLERK'S STAFF Z7
Annual Registration fee: [ ]Yes[✓ ]No Amount Paid$ MCR#,�� 4 Date Pal
Lobbyist Registration Form received and verified by: '
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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MIAMIBEACHCity of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
CITY CLERK Office CityClerk @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.
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Signature: D e:
FACLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc