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Michael W. Larkin - Radi Koutcha MIAMI BE H 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, 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 MLarkinQBRZonina&aw.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: Radi Koutcha NAME OF PRINCIPAUCLIENT: First Stone Reunion,LLC 170 SE 14th Street, Suite 1002 Miami FL 33131 (Number ana Stree13 i a e (zip e /786)361-0971 radinakoutchaconseil.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: See Attached • IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: n:SPECIFIC LOBBY ISSUE: 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 1930 Bali Drive, Miami Beach,FL. Issue to be lobbied(Describe in detail): nl.CITY AGENCIESANDIVIDUALS 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 Tanning, Building, Public Works and Fire Department None Staff B, DRB, HPB, BOA, City Commission, and Land Use None Development Committee, as necessary Pursuant to City Code Section 2-482(8)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 None None Wone ILi RB I lam/ tc-, IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER): A) LOBBYIST DISCLOSURE:(Required): $500.00 per hour B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $500.00 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 lobbvina on a present or pending bid for goods,eauiDmgnt or services.or on a Dresent or pending award for goods.eauipment 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 &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 o: 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 1 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 Produced ID ZPersonally Form of Identification Form of Identification known(Lobbyist) Personally known(Principal) VII. SIGNATURE AND STAMP O CAISTINA DIANA GONZALEZ o. State of Florida, County of Miami-Dad '* •' MY COMMISSION#FF083128 State of Florida,County of Miami-Dade :.� :oQ€ Sworn to and subscribed before me 9 . - Sworn and subscribed before me '�oF ,' EXPIRES March 23 2018 This _day of o=61;R ,201 �407j 398-0153 Floridallotaryservice., m This I V ,2014 Signature of Public Notary—Sta a of orida ary—State of Florida Notarization of Lobbyist's 'nature Notarization of Principal's signature TO BE COMPLE ED BY CITY CLERK'S STAFF ONLY J Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid ELOISA ARIAS ' MY COMMISSION#FF149051 :.'EOv�?°•' EXPIRES August 7,2018 ' 1-307)39e•0153 Flo rida Notary Service.com F:\CLE istration Form.doc Revised 04/27/2012 MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfi.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 ade County Commission on Ethics and Public Trust. Signature bate FIRST sT*DNE KEUM00 , LLG LAST NAME FIRST NAME ADDRESS ABEL Julie 170 SE 14th St,Ste 1002,Miami,FL 33131 0.78% ADAMALY lJoher 170 SE 14th St,Ste 1002,Miami,FL 33131 0.78% ADAMALY Karine 170 SE 14th St,Ste 1002,Miami,FL 33131 0.79% 1AKBARALY ISAKINABAY 170 SE 14th St,Ste 1002,Miami,FL 33131 0.78% BIERRE Philippe 170 SE 14th St,Ste 1002,Miami,FL 33131 0.47% BITAINE JEAN FRANCOIS 170 SE 14th St,Ste 1002,Miami,FL 33131 1.78% BONNET MARIE CECILE 170 SE 14th St,Ste 1002,Miami,FL 33131 0.45% BONNET OLIVIER 1170 SE 14th St,Ste 1002,Miami,FL 33131 0.45% BRUNO ERICK 170 SE 14th St,Ste 1002,Miami,FL 33131 2.25% CAZANOVE Alain Jean David 170 SE 14th St,Ste 1002,Miami,FL 33131 0.79% CHABRE Camille 170 SE 14th St,Ste 1002,Miami,FL 33131 0.94% CHABRE Laurent 170 SE 14th St,Ste 1002,Miami,FL 33131 0.94% CHAN FAT Maurice 170 SE 14th St,Ste 1002,Miami,FL 33131 1.15% CHAN FAT Gilberte 170 SE 14th St,Ste 1002,Miami,FL 33131 1.15% CLAVIER GUILLAUME 170 SE 14th St,Ste 1002,Miami,FL 33131 1.50% COLOMB ROSETTE 170 SE 14th St,Ste 1002,Miami,FL 33131 1.05% COLOMB JEAN JACQUES 170 SE 14th St,Ste 1002,Miami,FL 33131 1.05% COURNE Jean Christophe 170 SE 14th St,Ste 1002,Miami,FL 33131 0.78% CREN 170 SE 14th St,Ste 1002,Miami,FL 33131 0.47% DEBEUX ERIC 170 SE 14th St,Ste 1002,Miami,FL 33131 0.31% DEBLONDE Jacques-Francois 170 SE 14th St,Ste 1002,Miami,FL 33131 1.57% DIJOUX Josian 170 SE 14th St,Ste 1002,Miami,FL 33131 0.31% DRISS VINCENT 170 SE 14th St,Ste 1002,Miami,FL 33131 0.16% DUFFOURC MARYVONNE 170 SE 14th St,Ste 1002,Miami,FL 33131 2.75% I FAUTREL JEAN MARC 170 SE 14th St,Ste 1002,Miami,FL 33131 3.05% GALLOT BERNARD 170 SE 14th St,Ste 1002,Miami,FL 33131 3.00% GREFFARD Patrick 170 SE 14th St,Ste 1002,Miami,FL 33131 0.94% HOARAU CHANTAL 170 SE 14th St,Ste 1002,Miami,FL 33131 1.09% HOARAU MARTINE 170 SE 14th St,Ste 1002,Miami,FL 33131 2.23% HOARAU PATRICK 170 SE 14th St,Ste 1002,Miami,FL 33131 2.23% HOARAU Jacqueline 170 SE 14th St,Ste 1002,Miami,FL 33131 6.22% HOARAU Marie Louise 170 SE 14th St,Ste 1002,Miami,FL 33131 0.47% HOARAU Michel 170 SE 14th St,Ste 1002,Miami,FL 33131 0.47% HOARAU Sandra 170 SE 14th St,Ste 1002,Miami,FL 33131 0.78% ISLER THIERRY 170 SE 14th St,Ste 1002,Miami,FL 33131 0.75% KOYTCHA Dev 170 SE 14th St,Ste 1002,Miami,FL 33131 0.78% KOYTCHA Radj 170 SE 14th St,Ste 1002,Miami,FL 33131 1.57% KHOURY Jean 170 SE 14th St,Ste 1002,Miami,FL 33131 0.78% LANGLOIS ADRIEN 170 SE 14th St,Ste 1002,Miami,FL 33131 1.19% LAW LIN MARIE ANGE 170 SE 14th St,Ste 1002,Miami,FL 33131 2.89% LAW YAT Noel 170 SE 14th St,Ste 1002,Miami,FL 33131 0.63% LAW YAT Rosernay 170 SE 14th St,Ste 1002,Miami,FL 33131 0.63% LEANDRI PASCAL 170 SE 14th St,Ste 1002,Miami,FL 33131 4.65% LECLERC PHILIPPE 170 SE 14th St,Ste 1002,Miami,FL 33131 0.45% LECLERC HABY 170 SE 14th St,Ste 1002,Miami,FL 33131 0.45% LECLERC ROSELYNE 170 SE 14th St,Ste 1002,Miami,FL 33131 3.00% LEGENDRE IGis&le 170 SE 14th St,Ste 1002,Miami,FL 33131 0.78% I LEMARINEL Michel 170 SE 14th St,Ste 1002,Miami,FL 33131 1.57% LOCK KOON Bruno 170 SE 14th St,Ste 1002,Miami,FL 33131 0.31% LORION Fred 170 SE 14th St,Ste 1002,Miami,FL 33131 1.57% LORION Thierry 170 SE 14th St,Ste 1002,Miami,FL 33131 0.78% LORION Thierry 170 SE 14th St,Ste 1002,Miami,FL 33131 0.76% LUCINE Monique 170 SE 14th St,Ste 1002,Miami,FL 33131 0.79% MAMODE Amine 170 SE 14th St,Ste 1002,Miami,FL 33131 1.49% MARCHETTI Caroline 170 SE 14th St,Ste 1002,Miami,FL 33131 0.47% MOREAU Sonia 170 SE 14th St,Ste 1002,Miami,FL 33131 3.07% PRIGNON Heline 170 SE 14th St,Ste 1002,Miami,FL 33131 0.47% REY-MILLET Pierre Max Joseph 170 SE 14th St,Ste 1002,Miami,FL 33131 0.78% RIVIERE Jean Francois 170 SE 14th St,Ste 1002,Miami,FL 33131 0.47% ROBERT Isabelle 170 SE 14th St,Ste 1002,Miami,FL 33131 2.98% RUETTE EMMANUEL 170 SE 14th St,Ste 1002,Miami,FL 33131 0.77% SANASSEE RAJ 170 SE 14th St,Ste 1002,Miami,FL 33131 1.15% SAUVETRE Mickael 170 SE 14th St,Ste 1002,Miami,FL 33131 0.78% SAY LIANG FAT Michel 170 SE 14th St,Ste 1002,Miami,FL 33131 4.70% SOUPRAYENMESTRY JEAN FABRICE 170 SE 14th St,Ste 1002,Miami,FL 33131 1.50% MAMODE Annar 170 SE 14th St,Ste 1002,Miami,FL 33131 1.57% VACCARO Thierry 170 SE 14th St,Ste 1002,Miami,FL 33131 0.78% r VIRAMOUTOU EDWIGE 170 SE 14th St,Ste 1002,Miami,FL 33131 4.58% WELMENT Lina 170.SE 14th St,Ste 1002,Miami,FL 33131 0.79% SLT 170 SE 14th St,Ste 1002,Miami,FL 33131 1.57% SELLES MARTINE 170 SE 14th St,Ste 1002,Miami,FL 33131 2.35% SEGUIER Anne 170 SE 14th St,Ste 1002,Miami,FL 33131 0.23% r ISELLES Martine 1170 SE 14th St,Ste 1002,Miami,FL 33131 1.27% i AM 11 CL m �.._ _ . . 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