Michael W. Larkin - SG&LL Ventures, LLC -19 511 Pk A- L
MIAMI
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 331390 6 . �.w 'y �, it: I I
LOBBYIST REGISTRATION FORM u - defeat_
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage a the assa e, r (t
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, PLLC 200 S. Biscayne Blvd., Suite 850 Nftami, FL 33134
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305)374-5300 005)377-6222 MLarkin(dBRZoningLaw.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:
SG&LL Ventures. LC
NAME OF PRINCIPAUCLIENT:
SG&LL Ventures, LW 175 SW 7 St., Suite 1705 Miami Florida 33130
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
1305)459-3867
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:Shamsuddin Lalani,Managing Member
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST:Shcunsuddin Lalani(100%)
II.SPECIFIC LOBBY ISSUE:
annrovls arm Aermittina-issuPs Tor x-ro_pe ated:at 254 Palm Avenue
Issue to be 1o66ied'(Describein 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,staff ng the nature of the subject contractual relationship. _
Sec 2-482(a)(4) Full Name of Individual Contractual Relationship(Explain) YES NO
and
Staff for the Planning Department, Building Department, None X
Public Works, City administration, PB, HPB, BOA None X
DRB, City Commission and Mayor, as necessary 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
None
None
None
F:\CLER\$ALL1aFORMS\LOBBYISTFORMS\LobbyistRegistrationForm.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required)$ u.00 per hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $ -&.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 lobbying on a present or pending bid for aoods.eauioment or services.or on a present or nendina
Sward for aoods.eauioment 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 nendina application for a Development Aareement with the City or application
• 1. 1•- • • 1 1!' • 1" Y 11• II=r7
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 XNo; Are you renresentina 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
j_QB 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 require nts.
Signature of Lobbyist: •`'s'1'„/�'%
I! v_
Signature o Prin/ciipal/C ennt:t
°—
VI. IDENTIFICATION: IDENTIFICATION:
0 r-
Z_Produced I[(DELL'15O f O/(/ct D _Produced ID
3 g
Form of Identification Form of Identification H Q n
m = z
rn
X A
Personally known(Lobbyist) onally known(Principal) T H c
VII. SIGNATURE AND STAMP OF NOTARY:
r■ N
State of Florida, County of Miami-Dade ,Y Maria Victoria Diaz State of Florida, County of Miami-Dade
•
Sworn to and subscrib 4 1be1fOore me NOTARY PUBLIC Swom rid subscrib-• b-fore me
This QI d of
2016_ STATE OF FLORIDA This day of 2016_
aia7&'°• Comm#FF931817 /••
Expires 10/2; _I . �f�_ _-- , r
Signat a of P lic Notary—State of Florida Signatu - of''ublic Notary—State of Florida
Notari ation of Lobbyist's signature Notarization of Principal's signature
TO BE COMPLETED BY CITY CLERK'S S F ONLY
Annual Registration fee: [ ]Yes[ No Amount Paid$ M SO Co R# S Date Paid .0 f 47--
Lobbyist Registration Form received`�nd verified by: i(j Ofs3 i Er Revised 01/22/2014
F:I CLER\$ALL\aFORMS\LOBBYISTFORMS\LobbyistRegistrationForm.doc
MIAM.J
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, Esq.
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 $50.00 a day shall be assessed for all
Statement(s) filed after the due date. The City Clerk shall notify the Miami-Dade
County Commission on Ethics and Public Trust of the failure of a lobbyist (or principal)
to file the Statement or pay the assessed fines after notification.
Any lobbyist, who fails to file the required Statement by April 30th, 2014, shall be
automatically suspended from lobbying until all fines are paid, unless the fine has been
appealed to the Miami-Dade County Commission on Ethics and Public Trust.
Signature: Date:
F:\CLER1$ALL1 aFORMS\LOBBYISTFORMS\LobbyistRegistrationForm.doc
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