Michael W. Larkin - Shawn Vardi Plymouth Hotel ti
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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.I)
Bercow Radell & Fernandez, PA 200 South Biscayne Blvd., Suite 850 Miami Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)374-5300 (305)377-6222 mlarkiliQbrzoninalaw.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:
Shawn Vardi
NAME OF PRINCIPAUCLIENT:
Plymouth Hotel, LLC Plymouth Hotel, LLC 336 21 Street, LLC Miami Beach Florida 33139
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(516)606-0900
TELEPHONE NUMBER: FAX NUMBER:(Optional) EMAIL:(Optional)
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)]
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• NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: SVZLWVV °
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• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IWSUC tDRPORATION,
PARTNERSHIP OR TRUST: Ddi_
ILSPECIFIC LOBBY ISSUE:
Develo ment Board Aggrovals for Plymouth Hotel LLC-336 21 Street Miami Beach Florida 33139
Issue to be lobbied(Describe in detail): -�
Ill. CITY AGENCIES/INDIVIDUALS TO 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 NO
title of person to be lobbied
Planning Department and Building Department Staff None X
B, 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(8)Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)
$445.00
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). $445.00
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":
_Yes X No: Are you lobbying on a present or pending bid for goods,eauil2ment or services,or on a present or
pending award for goods.eauiprnent 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 lobbying on a oendina application for a Development Agreement with the City or application
f.qL chanae of zoning map desianation or chance to the Cites 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 representing 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 CLERIC A SIGNED STATEMENT UNDER
OATH. LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, IN THE CITY OF MIAMI BEACH
EM 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. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID 2 _Produced ID
Form of Identification o CO Form of Identification
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Personally known(Lobbyist) 9 E.o° —Personally known(Principal)
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VII. SIGNATURE AND STAMP OF NOTARY: z c v LD
z°bow
State of Florida, County of Miami-Dade .. State of Florida, County of Miami-Dade
Sworn and subscrib efore me ` %0 Sworn and subscribed before me
This y of rtrh6 ,2013 This day of ,2013
�i
Sign u e of Public Notary—State of Florida Signature of Public Notary—State of Florida
Notarization of Lobbyist's signature Notarization of Prin®signature
TO BE COMPLETED BY CITY CLERK'S STAF ONL
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# C� 9 Date Paid -`
Lobbyist Registration Form received and ve-rifled y.
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) $445.00
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(REQUIRED). $445.00
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":
_Yes X No: Are you lobbying on a present or pending bid for goods.eauioment or services.or on a oresent or
pending award for goods.eauioment 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 lobbying on a pending application for a Development Agreement with the City or application
fqE change of zoning 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 No: Are you representing 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
EM 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: 1111 hAA
V Vv- V
VI. LOBBYIST IDENTIFI TION: PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identification
Personally known(Lobbyist) XPersonally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade K%- AURORA DILLON State of Florida, County of Miami-Dade
MY COW&SSION 0 FF040045
Sworn to and subscribed before me �,2017 Sworn and subscribed bef re me
This day of ,2013 q+a� WIM. This day of P ,2013
if
Signature of Public Notary—State of Florida Signature bf Public Notary—State of Florida
Notarization of Lobbyt;rt'ssignature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid
Lobbyist Registration Form receive and verified y:
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F:�CLE istration Form.doc Revised 04/27/2012
MIAMIBEACH
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
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.
1
Signature: Date:
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Exhibit B:Corporate Disclosure
Plymouth Hotel
100%owned by Plymouth Hotel LLC
Agent:Shawn Vardi
336 21St Street
Miami Beach FL 33139
Plymouth Hotel LLC owned by:
Owner Name Percentage Address Suite/Apt City State Zip
Sabah Shemel 11.88% 109 West 27th 9E New York NY 10001
Street
Danny Mashaal 11.88% 12 Overlook Court Locust Valley NY 11560
Raymond 11.88% 16 The Loch Roslyn Estates NY 11576
Aboody
Jamil Ezra 11.88% 131 Mercer Street New York NY 10012
Joseph Ezra 11.88% 22 Keimel Court West Orange NJ 07052"
Dan Nir 11.88% 4 East 66th Street 5 FL New York NY 10065
Chandru 7.42% 10 Norden Lane Huntington NY 11746
Mahtani Station
Kirk Gellin 7.42% 1375 Broadway 2 FL New York NY 10018
Shawn Vardi 4.64% 2155 Washington 503n Miami Beach FL 33139
Ct
Mark Shemel 4.64% 300 East 55th 5E New York NY 10022
Street
Hunter Gellin 4.64% 1375 Broadway 2 FL New York NY 10018
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