Michael W. Larkin - Quinta Criolla, LLC '
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City of Miami Beach Office of the City Clerk
1700 Convention Center [}hve. Miami B88Ch, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by principal who seeks to encourage the pa000ge, defeat or
modification of any ondinonco, eoo|udon, action or decision of any commissioner; any oct|on, deoio|on, recommendation of the City
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Manager or any city board or committee; or any ocu|on, decision or recommendation of any city personnel during the time period of the
entire decision-making pmoeon on such ocu|un, ueo|a|on or recommendation that foreaeeomy will be heard or reviewed by the
city commission, or o city board or committee. The tann specifically includes the principal as well as any employee engaged in
lobbying activities. The term"Lobbyiatu"has specific exclusions. Please refer tm Ordinance oq0*'343m.
Larkin Michael W.
.`=,.E OF LOBBYIST: `^~~/ ` (First) ",.^/
Bercow RodeD Biscayne Blvd., Miami,
uuu/mEuu m*mE AND ADDRESS (Number and Street) (unv) (State) (Zip Code)
305-377-6231 305-377-6222 MLarkinaBRZbnin�&aw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
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Please notify this office if your contact information changes:address,phone, or e-mail address.
|. LOBBYIST msnwmsoBY:
NAME OF PRINCIPAUCLIENT:
20773 NW 581h Street, # 603 Doral FL 33178
BUSINESS NAME AND ADDRESS(Number and Street) (City) (State) (Zip Code)
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(786)515-8229 oscan-ii,,gastu ado.com. _q
TELEPHONE NUMBER: FAX NUMBER:(opuona0 EMAIL:(Optional) -1 `= X �
Fill out this section if principal is a Corporation,Partnership or Trust[Section 2-482(c)]
NAME OF CHIEF OFFICER,PARTNER,OR BENEFICIARY: Vidal Bada Vazquez-50%and Alejandra Bada Vazquez�50% (Jrl
IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORP-ORATION,
PARTNERSHIP OR TRUST: See the attached. ;i71
ii.SPECIFIC LOBBY ISSUE:
Development Approvals and Per7nitting Issues, including, but not limited to Design Review Board, Planning Board, Board of
AdiListment and Citu Commission, if necessaru, relating to the orol2ertu located at 1828 Bay Road, Miami Beach, FL
Issue to be lobbied(Describe in detail):
m. CITY AGENCUEWUNDUVUDUALS TO BE LOBBIED:
Pursuant to ouv Como monuvn 2-482(a)(*)mmuuo the commissioner or vomonno/sought to be/ouuwm,and whether the lobbyist has entered
into any contractual relationship (paid or unpaid) with said onv 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 I NO
title of person to be lobbied
Planning Department and Building Department Staff, None X
PB, DRB, HPB, BOA, City Commission, and Land Use None X
Development Committee, as necessary None y
Pursuant to City Code Section 2482(g)Eregistrant shall uo required mostate the extent n,any business,financial,familial orprofessional
relationship,o,other relationship giving rise toan appearance ovun impropriety,with any current city commissioner n,city personnel who is
sought moue lobbied ao identified vn the lobbyist registration form n|od.'
Sec 2-482(g)Any Financial,Familial or Professional Relationship
None
Nonp
None
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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 per hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $475.00 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 lobbying on a present or pending bid for good s.eauinment or services.or on a present or
pending award for goods.eguipment 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 pending application for a Development Agreement with the City or application
LQr chanag of zoning map designation or change to the Cit)'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 on 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:
VI. LOBBYIST IDENTIFICATI PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification Form of Identification
Personally known(Lobbyist) Personally known(Principal) z "
VII. SIGNATURE AND STAMP OF NOTARY: m
2
State of Florida,County of Miami-Dade ° State of Florida, County of Miami-Dade
Sworn,tq nd so§cribed befor�p�m��e z Swor nd cri d fore me 2
This k of f�YJt!`4fl13 �,®m This ay 2013 0
Signatu of ry—State of Florida ;, - Signature of is o ate of Floridan o Notariz tion signature - Notarization f signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Lobbyist Registration Form received and verified by:
i^i 1:yhoi.l „j F!,u Revised 04/27/2012
Citi (it'Miami Reach, 1700 1 1 1
Convention Center Drive, Miami leach, Florida 33139, www.ni aill beachfl.gov
CITY CLFRK Of ices
161•lacl F. (franado. Cily Clerk
Td: 305.673.7411 . Fax: 305.673.7254
LOBBYIST NAME: Michael 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 ) la 0o
Signature Date
CITY OF MIAMI BEACH
DEVELOPMENT REVIEW BOARD APPLICATION
DISCLOSURE OF INTEREST
1.CORPORATION
If the property which is the subject of the application is owned or leased by a CORPORATION,list ALL of the stockholders,and
the percentage of stock owned by each. Where the stockholders consist of another corporation(s),trustee(s),partnerships)or
other similar entity,further disclosure shall be required which discloses the identity of the individual(s)(natural persons)having
the ultimate ownership interest in the entity.*
OUINTA CRIOLLA LLC
CORPORATION NAME
NAME AND ADDRESS %OF STOCK
VIDAL BADA VAZQUEZ 500
10773 NTh' 58TH STREET, # 603
D0RAL, FT_.__3-3178
ALEJANDRA RADA VAZQUEZ
10773 NW 58TH STREET, # 603
DORAL. FL 33178
CORPORATION NAME
NAME AND ADDRESS %OF STOCK
IF THERE ARE ADDITIONAL CORPORATIONS,LIST OTHERS,INCLUDING CORP. NAME(S)AND EACH INDIVIDUAL
STOCKHOLDER'S NAME,ADDRESS, OFFICE AND PERCENTAGE OF STOCK ON SEPARATE PAGE
NOTE."Notarized signature required on page 8
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