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Michael Larkin - Mort Brous MIAMI BEACH City of Miami Beach Office of the City Clerk ' 1700 Convention Center Drive, Miami Beach, FL 331 W JANI _b PN 4; 28 LOBBYIST REGISTRATION FORM Lobbyist means all persons employed or retained,whether paid or not, by a principal who seeks to`encoura6e-the°pass�ge,16efeat 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.I) Bercow Radell & Fernandez, P.A. 200 South Biscayne Boulevard, # 850, MiamiFL 33131 BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-377-6231 305-377-6222 MLarkin @BRZoningLaw.com Please notify this office if your contact information changes:address,phone, or e-mail address. I. LOBBYIST RETAINED BY: Mort Brous /^1 ICdIT. Arbo Miami LLC 120 West Rivo Alto Drive, Miami Beach Florida 33139 Rl1SINF��NAMF AND A DRFRR (Numhpr anA Strantl (ritvl IRtntpl 17in Cnrlal 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: /J/Jo�►/ /191" _A • IDENTIFY ALL PERSONS HOLDING,DIRECTLY QR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST ` wrl-- ao .SPECIFIC LOBBY ISSUE: Development Approvals and Permitting Issues, including, but not limited to Historic Preservation Board, Planning and Board of Adjustment approvals for the properties located at 120 West Rivo Alto Drive, Miami Beach, FL. 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. PB, DRB, HPB, BOA, FP, City Commission, LUDC, and None. Commission Committees, as necessary None. 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 w is sought to be lobbied as identified on the lobbyist registration form filed. Sec 2-482(g)Any Financial,Familial or Professional Relationship f None. None. None. C:\Users\clerhatl\AppData\LocalWlicrosoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc a IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required)$475.00/hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $475.00/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 XNo: Are you lobbying on a present pe�pending bid for goods,equipment or services or on a present or pending award for gods,equipment or service? 2) Pursuant to Miami Beach City Code Section 2-490 Entitled°Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": _Yes XNo: Are you lobbying on a ep ndeng application for a DevelopMent Development Agreement with the Cit;or application for change of zoning,map designation or chan a 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 XNo: 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 FOR THE PRECEDING CALENDAR YEAR_ A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES n_iz_ 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: ZPRINCIPAL IDENTIFICATION: Produced ID is State of Flodda Produced ID 1 y�rs I i0PP R r p Notary publ oiana Ramos Form of Identi My Commisswn EEo82284 Form of Identification dD Expwea 0411012015 Personally known(Lobbyist) � known(Principal) P .State°t i.20A1 g1 VII. SIGNATURE AND STAMP OF NOTARY: $ •= MY Co410�► FF o4a2 State of Florida,County of Miami-Dade ; ,; ►`� tate of Florida,County of Miami-Dade Sworn lynd subscrib before me Sworn qnd subscribed before me Thi d of ►'J1�,2013 T, 's day w+ 2013 Sign ure ot Public Notary—State o on a Sign#ture of u is Notary—State o on a Notarization of obbyist's signature Notarization of Principal's signature TO BE COMPLETED BY CITY CLERK'S ST F Annual Registration fee: Yes o Amount Paid$= T g [ ] MCR# Date Paid 10 U ss,,,�,j t 3 0-�� 55�� MIAMI BEACH 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. An lobbyist, who fails to file the required Statement b Aril 30th 2012 shall be Y Y � 4 Y P automatically uspended from lobbying until all fines are aid, unless the fine has been Y Y 9 P appealed to the Miami-Dade County Commission on Ethics and Public Trust. !�- I( I a al Signature: ate: C:\Users\clerhatl\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration Formrevised 5-30-2012.doc f A Miscellaneous Cash Receipt c ; .��, �_y CITY OF MIAMI BEACH N0, El Cash ❑Credit Card Check# -7A;,4- 20 1. Received of AQ i4 Address f'PG }�✓��^ s�� 3i��lA �� 3 �'V i � . �-t, �irt� � rM��,� �'1+M��1�J� 4 r (THIS INFORMATION MUST RE COMPLETED). Office of_;Fi6in" ce Director By Account Number: r { EXT Preparers"% Dept: -°; ► ;f a 'j o