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Michael W. Larkin - 418 Meridian, LLC Roberto D. Colmenero 1 � ' Jr' ; V`AC H r' •� S { s / ! !t i` i 1 -atti 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 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 (30&27_7-6222 mlarkin@brzoninafaw com TELEPHONE NUMBER. FAX NUMBER: EMAIL: Please notify this office if your contact information changes:address,phone, or e-mail address. 1. LOBBYIST RETAINED BY: 418 Meridian, LLC C/o Roberto D.Colm er NAME OF PRINCIPAUCLIEN i. - Same La Pampa 1534 3 A(C1428AQ0) Buenos Aires Argentina Murnuer ana Street) r ate rp e 4706.0209 n/a die-qo@urbanica.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: Roberto D.Colmenero,Manager --a -- C/) • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH C,660hI�TfON, PARTNERSHIP OR TRUST. See attached. wSPECIFiC LOEEY ISSUE. DeveloUment ap provals&perMtiM issue oncernin 418-A26 Meridian Avenue. ' issue to be lobbied(Describe in detail): _' '• C, Ill. CITY AGENCI.ESiINDIVIDUALS--:TO:.BE.LCil§BIED: 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 arson's commencement of service with the city to the present date,stating the general nature of the subject contractual reiationshi . 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 D artment PB,HPB,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( Any Financial,Familial or Professional Relationship None C:1Usersl cierhatMppData\LocaflMicrosoft\Windows\Temporary Internet FileslContent.Outlook183LGQDDHILobbyist Registration 60' r� Formrevised 5-30-2012.doc , IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required) $475/hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): (REQUIRED)_ 475/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: AEUou lobbying oo a oresen`t or 2gndina bid for aoodc eauioment,o_ r rvi&es �or oRa g cp .,ding award for goods, au0pm nt or s¢ re?, 2) Pursuant to Miami Beach City Code Section 2.490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate Development issues": „Yes X No: chanae of zonina 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 X NoLArg you representing a not-for-profit corporation or entity without sj3ecIa1 comnel3,tion or raimbUmemel3t. V. SIGNATURE UNDER OATH: ON FEBRUARY 28 OF EACH YEAR EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK-A sirgNEp STATEMENT UNDER OATH. LISTING LOBBYING EXPENDITURES AS WE icn �s,� TIE ...I., E� �,�COMPENSATtO(� R I` ... �� „ , OF MIAMI BEACH THg EXPENDITU=0R COMPENSATION DURING THE REPORTING PERtnn 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: e7 B f.l C,L VI. LOBBYIST IDENTIFICATION: )6 PRINCIPAL IDENTIFICATION: Produced ID Produced ID -1 �1�_ p Form of Identification Personally known(Lobbyist) Form of Identification Pe i —Personally ly known(Principal) VII. SIGNATURE AND STAMP OF CRISTiNA D.:#DD AL.EZ State of Florida, *; ` +ti'COMMISSIO 960888 State of Flori da,Count of Miami-Dade County of Miami-Dade y Swom to and subscribed before me ' EXPIRES:Ma ,2014°Q'' Bonded Thru Notary nderwriters Sworn d subscribe before me � This day of 013 - This TLdayof ,2013 . MEYER FWCHEL Signature of Public Notary—S@te of F da Signature of Public Nota #EE 088019 Notarization of Labb�vist's signature Notarization of k*M 20,2015 n o eo BWW Notary Semms TO BE COMPLETED?x CITY CLERK'S STAFF ONLY Annual Registration fee: Yes No Amount Paid$ � MCR# Date Paid Lobbyist Registration Form received and verified by: f L C:\Users\clerhatl\AppOata\Local\Microsoft\Windows\Temporary Internet Files\Content.Outiook183LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc istratio"Forni.doc Revised 04/27/2012 ai 55 0 Uty of Nflanii Beach, 1700 Convention Center Drive,Miami Beach.. Florida 33139. 1A,%1v.niiamibeachfl.gov o'ry CLERK Office Rafael E.Granado. City Clerk GlyClerk@4i.flatnibeaclifl.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 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, 2014, 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: I�ICM3_ Date: C:\Users\clerhatl\AppData\Locahmicrosoft\Windows\Temporary Internet Files\Content.OuVook183LGQDDH\Lobbyist Registration Forrnrevised 5-30-2012.doc Lw e O ': j. -. y : . S W - . Uj - . y V U o FE- LL :c LL