Michael W. Larkin - 5520 La Gorce Dr. LLCIIPrr7,— , . . : :. , : , .
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City of Miami Beach Office of the City Clerk
1700 Conven3ion Center Dive, Miaa'l Beach, FL 33139
LOBBYIST REGISTRATION FOR;J1
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.
a 1138f W. W ck e
NAME OF LOBBYIST: (Last) (First) (M•i)
W• TUC K=,‘ G i( , o A &P .c y )PIA Ca— coaxur 4, 4J1? -, - 3 313 3
'BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305= q / -el Pao 3A yy�- en 23 utkec a, 1,4)&i bal•
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes :address,p -n
hone,or address. - .
I. LOBBYIST RETAINED BY:
&OS- L iA)C J P..49.40 &.,, -d ( ,A44- aAl1ft m ,4s-crreiAYi Ati i4zs.
NAME OF PRINCIPAL/CLIENT:
&o c L-h 1 z.A) (24,:w 4f)iA,ii i- - 33/3c
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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: �.!
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: ./
.� : f � H�'-o i d LL P /2/i�17 MJ d e/ �7° '40,7 Jrx(,t
ILSPECIFIwCLOBBY ISSUE
ivy ' -144,0 are), eoar Lm4an /2.0.z. .
Issue to be lobbied(Describe in detail):
III.CI.T`il a►GENCIESfl '. , �.
�.� I�DIV�DUAL��Q�Ea,L®BBIED:
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
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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 oft•
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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F r IV. DISCLOSURE'OF T "RMS AMID AMOUNTS OF LOBBYIST CO;41 :ENS. Tia:.M j DISCLOS .W ,c ME? OU�-',L FAT RATE OR 07-1E R):
A) LOBBYIST DISCLOSURE:(Rag/Jir9d'
;3) PRINCIPAL'S DISCLOSURE(OF L O YlST COMPENS a T ION):
(REQUIRED). $ crn: /lei- hA4r
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2483 Entitled"Prohibited Campaign Contributions By Lobbyists On Procurement
Issues":
_Yes)(No: Are .ou lobb in• on a oresent or Fendia bid for 'cods a•ui meat or services or on a resent or cendin•
award for goods,equipment or service?
2) Pursuant to Miami Beach City Code Section 2-490 Entitled"Prohibited Campaign Contributions By Lobbyists On Real Estate
Development Issues":
Yes)(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 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./Po: 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 FOR
THE PRECEDING CALENDAR YEAR. A STATEMENT SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR
COMPENSATION DURING THE REPORTING PERIOD. ��,,//��
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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/B'each City Code and all reporting requirements.
Signature of Lobbyist:
, 4 6,......._ .
Signature of Principal/Client:
VI. LOBBYIST IDENTIFICATION: b q7 h PRINCIPAL IDENTIFICATION:
P Lk�ee�sLC "ay n �' flf ID a ;� v A� `� � roduced ID EL �� yS r
�, '3 of Identification -i `'`
":Produced
Form of Identification Form o - _ " .V
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Personally known(Lobbyist) ' a c Personally known(Principal) a n (4 m o
VII. SIGNATURE AND STAMP OF NOTA- �oL��L� 'y 4...... E
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State of Florida,County of Miami-Dade to of Florida,County of Miami-Dade I c v
•```tt"'''� °p Swo subscrib- �f
• ,c •. •, , _ • .efor me LL z
Sworn to -�• subscrib�d •- •r: me 'fey iQ.,; `� I + t / ,201�J
This J y of t,e ,2012 i ♦'`r.► �; This i d- of muck •�,.,,,.,,
�. �!''� 4� �;, , % air'
Signature o ublic Nota -State of Florida ��''"`'•••, Signat re of Public Notary-State of Florida :r ',4°
Notarizatio of Lobbyist's signature Nota ation of Principal's signature 1�a,,,„�;,,,
TO BE COMPLETED BY$ITY CLERK'S ST F O� .Y G '/
Annual Registration fee: [ ]Yes[) No Amount Paid$ 3 MCR# if D L1/1b -Date Paid LYZ 5.
Lobbyist Registration Form receive and verified by: ��i*"`^--^
F:1CLFR\$ALOAFGGM5\LOBBYIST FOR 1S\Lobbyist Annual R sistratic Form.doc Revised 01/22/2014
F:ICLER\$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov
CITY CLERK Office
Rafael E.Granada,City Clerk CityClerk @miamibeachfl.gov
Tel: 305.673.741 1 ,Fax:305.673.7254
LOBBYIST NAME: W_____W,1_11____CerLa 3/
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$50.00 a day shall be assessed for all
Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust of the failure of a lobbyist(or principal)
to file the Statement or pay the assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30th of each year, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
A_._..A :ili
Signature: I Date:
F:ICLERI$ALL1aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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MIAMIBEACH
City of Miami Beach Office of the City Clerk � k�
y y .nn
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 8s Fernandez, PLLC 200 South Biscayne Boulevard, # 850, Miami FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-377-6231 305-377-6222 MLarkin(a,BRZoningLaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, ore-mail address.
I. LOBBYIST RETAINED BY:
5520 La Gorce Dr. LLC
NAME OF PRINCIPAUCLIENT:
170 SE 14th Street, #1002 Miami FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
786-361-0971 nascal(ki2f.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: Pascal Nicolai,Manager
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: Pascal Nicolai 100%
II.SPECIFIC LOBBY ISSUE:
Development Approvals and Permitting Issues relating to the property located at 5520 La Gorce Drive. Miami Beach, Florida.
Issue to be lobbied(Describe in detail):
Ill. 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, Building and Public Works staff None. X
PB, DRB, BOA, City Commission, and Land Use None. X
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 2-482(g)Any Financial, Familial or Professional Relationship
None.
None.
None.
11.1
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)$525.00/hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $525.00/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 XNo: Are you lobbvina on a present or Pending bid for goods.eauioment or services.or on a Present 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 XNo: Are you lobbvina on a Pending application for a Development Agreement with the City or application for
chanae of zonina map desianation or chanae to the City's Future Land Use Mao?
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. 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,
C \-
Signature of Lobbyist
I do solemnly swear that all of the foregoing facts ar- ue and correct and t j,•-have read or am familiar with the provisions contained
in Section 2-482 of the Miami Beach City Code . - I reporting require - .
Signature of Lobbyist:
Signature of Principal/Client: 4110.1"'. .
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID °pa.:..............."'a=; Produced ID ®�E .
Form of Identification 2 R.�\__�1" Form of Identification 'Z'3 °° -
b -.5, : ; Ott.. E
/Personally known(Lobbyist) " ml � n Personally known(Principal) 03 o re
VII. SIGNATURE AND STAMP OF NOTARY: c v 8 4 •�, "—:W
a m
State of Florida, County of Miami-Dade o K v State of Florida, County of Miami-Dade �` S a
Sworn to and subscribed before me cu cn n Sworn and subscribed before me
This i 3it, day of �' ( I 1.. 2015 c da of Y1 I ,2015 ��` `'',
y LW , .ham / ,
Signature of Public Notary— tate ff Fl ° N ° Si e of Public N —State of Florida =` �
g ry a o Sig S ate o o da mod,- , �,
Notarization of�,obbvist's signature CO r R Nota ization of Principal's,signature ''usuiistoo
TO BE COMPLETED BYRTY CLERK'S AF �p ! `
Annual Registration fee: [ ]Yes No Amount Paid$ 1 MCR# � l Date Paid / �!
Lobbyist Registration Form receive and verified by: refit Cc.,, ^-
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M I AM I BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.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-Dade County Commission on
Ethics and Public Trust.
CA bp-
Signature: Date:
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CITY OF MIAMI BEACH
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