Michael W. Larkin - 2901 JMH, LLC MI AAA I BEAC Fl City of Miami Beach Office of the
City Clerk XIO\
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 pas`sage,-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 F viewed:by the
city commission, or a city board or committee. The term specifically includes the Development Board Approvffs for-2901-11
Indian Creek Drive, Miami Beach, principal as well as any employee engaged in lobbying activities. The teem "1 bbyists" has
specific exclusions. Please refer to Ordinance 2004-3435. -C" .7
Larkin Michael W.
NAME OF LOBBYIST: (Last) (First) (M.I)
Bercow Radell & Fernandez 200 South Biscayne Blvd., Suite 850 Miami Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) ,(Zip Code)
(305) 374-5300 (305) 377-6222 mlarkinabrzoninalaw.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 Halpern
NAME OF PRINCIPAUCLIENT:
2901 JMH, LLC 184 Kent Avenue, C706 Brooklyn New York 12249
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 374-5300 iason. ar' imhdev.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: 14/06
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: ��
ii.SPECIFIC LOBBY ISSUE:
Development Board Approvals for 2901-11 Indian Creek Drive, Miami Beach, Florida
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
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 Staff, PB, HPB, BOA, DRB, Commission None X
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
NON
CAL)
C:\Users\clerhatlWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required):$525.00
(LID
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION):$525.00 t'
(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":
c.)
—Yes X No: Are you lobbvina on a present or pending bid for aoods.eauipment or services.or on a oresent or iendinq
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 lobbvina on a oendina application for a Development Aareement with the City or application for
chanae of zonina map desianation or chanae 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 No: 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
EQB 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:
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION: R %
o % b4.1
Produced ID Producedd ID o
Form of Identification 446
Form of Identification
rn�DZ Z
rs
Personally known(Lobbyist) Personally known (Principal) Sgicn
Oa ma,VII. SIGNATURE AND STAMP OF NOTARY: v; to N
8
of Florida, County of Miami-Dade o R. Sta - of Florida,/County of Miami-Dade m in-
State
Sworn d s crib d bef re me a Sworn .�d subscrib d bef a me
This d: of n , 2015 tO This day of fl ( , 2015.
\AN)'4 CA
Signat Pu• ' Notary–State of Florida Sign- use of Pu•is Notary–State of Florida
Notari - ion of LLbbvist's signature Notarization of - '� '•- signature
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes /]No Amount Paid$_ •vo MCR# -4 315? Date Paid 1/"Vi 1/"Vi 5
Lobb ist Re•istration Form receive• and verified b : 1 A
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Formrevised 5-30-2012.doc
F:\CLE istration Form.doc Revised 04/27/2012
M A M BEAC H c.,
zit
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, 4 www.miamibeachfl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerk @miamibbeachfl.gov `>
Tel 305 673.7411 , Fax: 305.673.7254 _A
..� ¢+
-,-i a ' .
Cr
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-Dade County Commission on Ethics and Public Trust.
g"/*
Signature: Date:
C:\Users\clerhatlWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\83LGQDDH\Lobbyist Registration
Formrevised 5-30-2012.doc
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CITY HALL CASHIER OFFI
1700 CONVENTION CNTR DR
MIAMI BEACH, FL 33139
„ 04/14/2015 15:39:36
_ Merchant ID: 000000005148978
i.
�' Terminal ID: 02013135
• .. ..... 1090573940
CREDIT CARD
AMEX SALE
CARD# XXX>0000000(1057
INVOICE 0025
City of Miami Beach-Florida Batch#: 001512
Finance Department Approval Code: 504200
Entry Method: Swiped
1 City Hall -
1510413-1 04/14/2015 BR1 1134 Mode: Online
Tue Apr14,2015 03:39Ph1 Trans#53-53 SALE AMOUNT $350,00
53 $350.00 MCRCLERK - MCR-City Clerk
* MCR#: 403452
1 ITEM(S): TOTAL: $350.00
Credit Car PAID $350.00 CUSTOMER COPY
Have a nice day!