Michael W. Larkin - Jason Rubell _ t .
[APA BEAC
City f Miami Beach Office of the City Clerk
Y /
1700 Convention Center Drive, Miami Beach, FL 33139 �e v
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, P.A., 200 S. Biscayne Blvd., #850, Miami, FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-377-6231 305-377-6222 MLarkin @BRZoningLaw.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:
Jason Rubell
NAME OF PRINCIPAUCLIENT:
.510 Lakeview Court Miami Beach FL 33140
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)913-1040
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: NlA
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:
u.SPECIFIC LOBBY ISSUEN
Development Approvals and Permitting Issues, including, but not limited to Historic Preservation Review Board, Planning Board, Board
of Adjustment, Land Use Development Committee, and City Commission, if necessary, relating to the property located at 510 Lakeview
Court, Miami Beach, FL.
Issue to be lobbied(Describe in detail):
ul. CITY -AGE NCIESIINDIVIDUALS T® BE
LOBBIE®:
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 eneral nature of the suNect contractual relationship.
ec 2-482(a)T4TFu1Wame of n ivi ua ancl uontractual e a ions ip(Explain
title of person to be lobbied
Planning, Building, Public Works and Fire Department Staff None
PS, DRB, HPB, BOA, City Commission, and Land Use None
Development Committee, as necessary
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 g Any Financial, I-amilial or Professional Relationship
i
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required): 5500.00 1701y
B)PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $500.00 DerhoUr
(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 Xou lobbying on a present or pending bird for goods,eauinment or services.or on a present or
pending award for goods.eauinment 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 lobbvina on a pending anglication for a Develooment Agreement with the City or application
fgt chance of zoning map designation or chance 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 Xo- ArP j(nu representing a not-for-profit corporation or antity wit�necial compenca ion or r_imb irs _m _n _
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 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.
,.••;��'�;•-., OSCAR M. Bnature of Lobbyist: _ •: : •= My Comm.Expir015
Commission :Na
Q.
Signature of Principal/Client:al/Client:_ ''•F;;;;;
9 P Bonded Through Natssn.
VI. LOBBYIST IDENTIFICATIO 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 State of Florida, County of Miami-Dade
Sworn to and subscribed before me Sworn and subscribed before me
This_ _day of_ ,2014 This 50- day of_064SW ,2014
Signature of Public Notary—State of Florida /otan f Public Notary—State of Florida
Notarization of�vi�st'_signature of Principal's signature
- ,. - " - -- -
/�
TO BE COMPLETED BY CITY CLERK'S STAFF
14 /Y--- --
Annual Registration fee. [ ]Yes.[ ]No
Amount Paid$: SO MCR#_ ?>6 _D to Paid Lobbyist Re!
a
M
O�
CL
o °
Q N O
O LO
N cn * i
cn O
O _ 3 T- m ZJ
c �l v N n m m `..
O N O
N
o
cn _ Cl) N _ CO >
p N >, 00
O- CL Cl) O a v
N O U .4-1 N 0 U � o�C w
w " J O
O O L U _ J �Z
U Cl) p N +' N O ~ 9 Y �
N C +, N O O N V C a W m Z
�— C .—, � C cv -o M �_ W
M O M U 0 Y U . C O Z = U o Z
+ cn - O N U N N O V Z -
d N O V L 70 N C L ;,;
L U cn L O in v Q
N CO U � N O N Q
L _
O O O �--� i E CL
.r O � rn
Ad
L V Cl) •L (n >> L >�_Q M c
_ L-
°° tJ C
Ew ++ C• +r,_V O p p N N O V O O Q °
-J W 4 c 0 C (�
>, U U a C -a N U O 'N C m
f r1 0 V O N > cn O ii 1 lC ca
�� U p U Cl) N = O N N O C Q L
'0 + N L CO) cu U +r U�.r 0 O N >, O U LL E
r O N C (b O CL O Q O }, E
� O O N L- U) cn +r O i C
c O p L N > O O a O E C cn >, V
W, 0 O
N � U a Q C -0 cm U) N .D O O o
N i V i U ; o
CD
Ln = N (� CD 41 i E
,J O® '
T N C
LO "-,M z
I
F:\C\61E FORMS\LOBBYIST FORMS\Lobbyist AnnualRegistratiorrForm.doc . _ Reviisea..04j27j2012
-§ AB
M IA-) I I ", EAQ H
City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.mianiibeachfl.gov
CITY CLERK Office
Rafael E.Granado,City Clerk CityClerk @miamibeachfl.gov
Tel:305.673.7411,Fax:305.673.7254
LOBBYIST NAME: AfIchael W Larkin
I understand that no later than February 28 of each yea , 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.
Signature Date d d 1
� a
T 7
, .o
s 3 �
" 'tip - - ••-
_ ®_ ;.
�- T
i W
s�Ap ca
6
Vy. U a - _� L
b