Michael Larkin - Robert Toll NIIAMIBEACH
V
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.I)
Bercow Radell&Fernandez, P.A. 200 South Biscayne Boulevard, # 850, Miami FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-377-6231 305-377-6222 MLarkinaaBRZoninaLaw.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:
Robert Toll
NAME OF PRINCIPAUCLIENT:
2500 Bay Avenue, Miami Beach FL 33140
(NUM Der ana Street) i y (State) (zip Mae)
215-938-8022 RTOLL(aollbrothersinc.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: Mark Lyn 100%
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
II.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 2500 Bay Avenue, Miami Beach, FL.
Issue to be lobbied(Describe in detail):
III. CITY AGENCIEWINDIVIDUALS 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.
B, 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 who is
sought to be lobbied as identified on the lobbyist registration form filed.
Sec 2-482(g)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 OTtfEN;
A) LOBBYIST DISCLOSURE:(Required)$500.00/hour
8) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $500.00/hour
(REQUIRED).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2.468 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Issues":
_Yes"go. AM you jobbVIMA on a DImsent or=dlna bid f9l; roods-equipment or WKWces-or on a®nasent or oendina
SQL¢ .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 XNo: Are you lobbying on anding application for ant wilb UM City or application for
Change of zontna man designation or chance to the CMs Future Land Use Mac?
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 2-461 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 indired, 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)No' Am`Mu reoMlentina a not-or-profit corpo.3k Will comoengegtion or[C jMburseme L
V. SIGNATURE UNDER OATH:
ON EERQUeRY 28 OF EACH YEAR, LOBBYIST SHOIt_SUBMIT TO THE CITY CLERK A SIGNED STAT�!+!ENT
nett' J SJING LOBEIXING EXPENDITU RES AS 11IELL AS COMPENSATION fILECEIVED- IN THE CITY OF MIAMI BEACH
cF�B TH P EC DING CALENDAR Ytg®R_ A STATEMENT SHALL BE FILED EVI`N IF THM HAVE BEEN NO
EXPENDITURES OR CQMpFNSATION DURI[dG THE REPORTING PERIOD.
Signature of Lobbyist
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 10 Produced ID
Form of Identification Form of Identification
Personally known(Lobbyist) Personally known(Principal)
VII. SIGNATURE AND STAMP OF NOTARY,
rY-!!mssY/y�p'�'41
Florid J
State of Florida,County of Miami-Dade State of- a,Count of
Sworn nd subscribed before me Svorm"d subscribed before me
This day of ,2014 This �3?7"' day of .2014
Sig a re rc —Sfafe o Iorida Signature of Public Notary—State of fleme vary/vi n;a
Noterizetio ' signature Notarization of sign re
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TO BE COMPLETED BY CITY CLERK'S gTAFF ONLY
Annual Registration flee: ( ]Yes[ 'No Amount Paid t = MCR a Data Pall
Labbylal Ra Istratlon Form rmmlvad andLyarIffed b
Aory ,,% BETTY LLERENA NOTARIAL SEAL
Notary Public•State of Florida KAREN A.FELICE,Notely Rft
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Cite of k1hin i [leach, 1700 Convention Center Drive, Miami Beach, Horida 33139, ww�v.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado. City Clerk CityClerkr��miainibeachfl.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.
i
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.
Signature: Date:
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