Michael W Larkin - 530 Lincoln Owner, LLC I
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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, PA 200 S. Biscayne Blvd, Suite 850, Miami, FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)377-6231 (305)377-6222 mlarkin @brzoninglaw.com
7ELEPHONE R: Fn NURBER: .
Please notify this office if your contact information changes:address,phone, or e-mail address.
I. LOBBYIST RETAINED BY:
_530 Lincoln Owner. LLC—David Edelstein, Manager
NAME OF PRINCIPAL/CLIENT:
Same 590 Madison Avenue,2111 Floor, New York NY 10022
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(212)521-4488 (212)521-4489
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: David Edelstein,Manager and Authorized Signatory
IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION,PARTNERSHIP OR TRUST: David Edelstein—60%;Jackie Mansfield—20%;Robert Futterman—20%.
II.SPECIFIC LOBBY SSUE:
Development aDarovals and Dermitting issues for 530 Lincoln Road
Issue to be lobbied(Describe in detail):
lll. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
Pursuant to City Code Section 2482(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 sub"ect contractual relationship.
Sec 2-482(a)(4) Full Name of Individual and Contractual Relationship(Explain) YES NO
title of person to be lobbied
Staff of Planning Department,Building Department and Public Works one
Denartment
B,HPB,BOA,City Commission,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(8)Any Financial,Familial or Professional Relationship
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)$500/hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION.): $500/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":
vas X No@ Are vau lobbyl ant or pending bid far goads equipment or services or on a present or gentling
award for goods.egujgment or Aervice4
2) Pursuant to Miami Beach City Code 2-490 Entitled°Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
_Y X b1ge Are you lobbving on a pending agpllcailo fora Development Agreement with the City or anntication far
Change f zon lna map 1gna o
3) Pursuant to Miami Beach City Code 2-484(h)Any person(except those exempt from the definition of"lobbyist°as set forth in
Section 2481 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 Na Are vau renresentlna a not for 2rofit oorooration or ent tv wits 112gclalcomgensatlon_or reimbursement. .
V. SIGNATURE UNDER OATH:
QN FE13SUARX 261b OF EACH YEAR r w.,■j . QBUYI JT fiHA1 1 S BM1T IQ THE CITY CLERK A SIGNED STATEMENT UNDER
OATH LISTING LOBBYING EXPENDITt1RES AS WELL AS COMEENSAT N R=1499- IN THE CITY QF MIAMI ag&GH
EXXEMIDITURES OR
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 require ents.
Signature of Lobbyist:
Signature of Principal/Client:
Vi. LOBBYIST IDENTIFICATION: $ ,,..• • ••..,, PRINCIPAL IDENTIFICATION: Z
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SIGNATURE AND STAMP OF NOTARY: s no
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State of Florida,County of Miami-Dade z N c State of ,County of g N m ro
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This 1�0 day of ,2014 o Z > This day o ,2014 " o c, Z
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Notarization of�i abst�signature Notarization of signature x
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TO BE COMPLETED BY CITY CLERK'S ST F ONLY L/
Annual Registration fee: Yes o Amount Paid$ •� M R# Date Paid I
Lobbyist Registration Form receive and verified by:
FACLERI$ALL1aF0RMSIL0BBYIST FORMS1Lobbyist Registration Formdoc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required)$500/hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $500/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 aoods.eauiament or services.or on a present or eR=g
award for goods.equipment or service?
2) Pursuant to Miami Beach City Code 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 for
chanae of zoning map designation or chanae to the City's Future Land Use Mao?
3) Pursuant to Miami Beach City Code 2-484 (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 No: Are you representing snot-for-profit corporation or entity without special compensation or reimbursement. .
V. SIGNATURE UNDER OATH:
ON FEBRUARY 28th 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
MR THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD,
See A "
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: PRINCIPAL IDENTIFICATION:
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State of Florida, County of Miami-Dade State of a,County of ® ° a �
Sworn to and subscribed before me Sworn ar subscribed b fo me
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This day of ,2014 This ® day o , 2014 .® o, -n n 0* Z
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Signature of Public Notary-State of Florida 7&gnature of Pub i otary-State of Florida ®� p
Notarization of Lobbvist's signature Notarization of signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: Yes No Amount Paid$ MCR# Date Paid
Lobbyist Registration Form received and verified by:
FACLEMMUaFORMSILOBBYIST FORMSTobbyist Registration Form.doc
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City of Miami Beach, 1700 Convenlion Center Drive,Mian►i 13cach,Florida 33139,www.miamibeachfl.gov
CITY CLERK Office CityClerkCniiatnibeacUO.gov
7e1:305.673.7411 ,Fax:305.673.7254
LOBBYIST NAME: Michael W.Larkin
I understand that no later than February 28th 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, 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 $50.00 a day shall be assessed for all Statement(s)
filed after the due date. The City Clerk shall notify the Miami-Dade County Commission on
Ethics and Public Trust of the failure of a lobbyist (or principal) to file the Statement or pay the
assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30th, 2014, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
Signature: Dat :
FACLERI$ALL1aFORMSILOBBYIST FORMS\Lobbyist Registration Fortn.doc
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