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City f Miami Beach Office of the City Clerk rI
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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.1)
Bercow Radell & Fernandez, PA 200 South Biscayne Blvd., Suite 850 Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 374-5300 (305) 377-6222 mlarkinCQbrzoninglaw.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:
2156 Sunset Lake, LLC
NAME OF PRINCIPAL/CLIENT:
2156 Sunset Lake, LLC 640 Fifth Avenue, 2011h Floor New York New York 10019
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(212) 688-2550
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: Jeffrey Altman
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: Jeffrey Altman 100%
II.SPECIFIC LOBBY ISSUE:
Developmental Board Approvals and Permitting Issues for 2156 N. Bay Road, Miami Beach, FL 33139
Issue to be lobbied(Describe in detail):
III. 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
erson.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
Commission, Planning Staff, Building Staff, None
Development Boards
Pursuant to City Code Section 2-482(g)Every registrant shall be required to state the extent of any business,financial,familial d4rofes"sional
relationship,or other relationship giving rise to an appearance of an impropriety,with any current city commissioner or city perspnnel-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
OTHER):
A) LOBBYIST DISCLOSURE:(Required)$500.00
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(Required). $500.00
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 lobbying on a present or Bending bid for aoods.eauipment or services. or on a present or
pending 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 lobbying on a pending application for a Development Agreement with the City or
application for change of zoning map designation or change to the City's Future Land Use Map?
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 XNo: Are you representing a not-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
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.
Signature of Lobbyist:
Signature of Principal/Client: I AIN J t. A-
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VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
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Form of Identification Form of Identification -� o
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Personally known (Lobbyist) : o .�
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(Principal)VII. SIGNATURE AND STAMP OF I z a
NOTARY: T
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State of Florida, County of Miami-Dade State of firn�;County of-Mi de a'
Sworn to and subscribed before me Sworn and subscribed before me
This day of 2014 This �'"� day of aPw. 2014 cs�NA,
Signature of Public Notary-State of Florida Signature of Publ' Notary-State of F ok&j- NkO [�r Le,
Notarization of Lobbyist's signature Notarization of Principal's signature
Annual Registration fee: [ ]Yes[ ]No Amount Paid$ 3:22 MCR# -379 01te Paid
Lobbyist Registration Form received and verified by:
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR
OTHER):
A) LOBBYIST DISCLOSURE:(Required)$500.00
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):
(Required). $500.00
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 Mending bid for goods,equipment or services,or on a present or
pending award for goods,eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
Yes No: A[eyo,_u lobtving on j i2endinq al2 lin cation for a Development Agreement with the City or
application for change of zoning mag dg_signation or change 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 XNo• Are you representing a not far profit corooration or entity witflout 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
Epa THE PRECEDING CALENDAR YEAR. A STATEMENT SMALL BE FILED EVEN IF THERE HAVE BEEN NO
EXPENDITURES OR COMPENSATION DURING THE REPORTING PERIOD.
Signature of Lobbyist 1
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:
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Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
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Produced ID __. Produced ID Z o a
Form of,ldentification Form of Identification N L
ersonally known(Lobbyist Peersonally� known > (I z
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;. CRISTINA DIANA GONZALEZ t
(Principal)VII. ;��,•; SIGNATURE AND STAMP OF a
t•I '' MY COMMISSION#FF083128
NOTARY: p
q�•••••••d� EXPIRES March 23,
7)398-0153 FlorldallotaryService.corri
State of Florida, County of Miami-D State of FfoTittd;County of44amt-Me V P
Sworn to and subscribed�4�efo��e me Sworn and subscribed before me
This 3� day of�%-ft " 2014 This -S'~0- day of L�Wen�, ,2014 .__.,.
Signature of Public tate. f Flor• a Signature of Publi Notary-State of F-lo �''JXLC'
Notarization of Notarization of Principal's signature If
TO RP COMPI FTED BY PITY f'1 FRK'S-SIAEE ONLY _._
Annual Registration fee: [ J Yes[ J No Amount Paid S MCR# 370�5� Date Paid 1`
Lobbyist Registration Form received and verified by:
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City o f M i a in i 11 ea c h, 1700 Convention Center Dive,Mian-d Beach, Florida 33139,w%,vw.mia jjbea chfl..&(1V
CT1Y CIERK Office C ity('Ierk(i.r.)iiia mibea ch fl.gov
Tel: 10 5.6 7 3.7 4 1 1 . Fa x! 3 0 5.6 7 3.7 2 5 4
LO B B Y IS T N A M E: Michael W. Larkin
I understand that no later than February 28th of each year, I nxist file the following
form, pur—suant to Section 2485 of the Mani Beach City Code, with the City Clerk's
O-ffice 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 0 ffice of lobbyist withdrawal in writing.
Pursuant to Section 2 4 8 5 (d), the City Clerk sha 11 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 48 5 . 1 . a fine of $50.00 a day sha )l be assessed for all Statement(s)
filed a fle r the due date. 4be City Clerk shall notify the Miami-Dade County Commission on
I'Ahics and Public "Trust of the fa ilure 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:
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