Michael W. Larkin - Washington Squared Owner, LLC 8 66 < <-1,53 5 J4shdt0,43I
locACri _ ,
City of Miami Beach Office of the City Clerk 2 APR 1 9 3: 23
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, PLLC. 200 S. Biscayne Boulevard, Suite 850, Miami, FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
305-377-6231 305- 77-6222 mlar ' • b rzonin•law.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
Please notify this office if your contact information changes:address,phone, ore-mail address.
I. LOBBYIST RETAINED BY:
Washington Squared Owner. LLC (contact: Andrew Joblon)
NAME OF PRINCIPAUCLIENT:
Same 425 Northwest 26th Street Miami FL 33127
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
aieturnbridgeeauities.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: Andrew Joblon, Manager
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: See attached.
Development approvals and permitting issues related to the properties located at 601=685 Washington Avenue.
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
Staff of Planning Department,Building Department,and Public Works Department None. '
X
PB,HPB,BOA,City Commission,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
— B
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYT C$ S /hE:(Required)
B) PRINCIP , 'S DI Le URE(OF LOBBYIST COMPENSATION):
(REQUIRED , • ', ;25/hour
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 goods.eauipment or services.or on a present or pending
award for aoods.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 lobbying on a pendina application for a Development Aareement with the City or application for
change of zoning map designation 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 reoresentina 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
EQ$ 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 re uirements.
Signature of Lobbyist:
Signature of Principal/Client: I —
VI. LOBBYIST IDENTIFICATION: gr PRINCIPAL IDENTIFICATION:
Produced ID Produced ID
Form of Identification 4 b1 Form of Identification
Personally known(Lobbyist) A ... (Principal)
,► °= ! 1 !A RUZZI�,VII. SIGNATURE AND STAMP OF NOTARY: N ,; -
`' ce 8pp.3g5��019
State of Florid a,County of Miami-Dade N k N a - , -. ty of Miami-Dade
Sworn to and subscribe before me g 3.a Sw F1 subscribed before me 7(0,
This , day •( ,201L '°-n c g Thii 7 day o l i �� ,201
N �d
Signature of Pubic Notary—State of Florida Sig otary State of Florida
Notarization of Lobbyist's signature Notarizatio,• Lio . signature
TO BE COMPLETED BY CITY CLERK' TAFF ONLY
Annual Registration fee: [ ]Yes[ No Amount Paid$ 's0 MCR# Date Paid 04- (c1--46
Lobbyist Registration Form received and verified by Revised 01/22/2014
i
mimm BEAC ,
k
City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachtl.gov
CITY CLERK Office
Rafael E. Granado, City Clerk CityClerkamiamibeachfl.gov
Tel: 305.673.7411, Fa x: 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)
Y Y (
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.
02/Irk a/1.
Signature: Date:
F:ICLER\$ALL1aFORMS\LOBBYISTFORMS\LobbyistRegistrationForm.doc
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1. Washington Squared Owner LLC 7. Michael Fascitelli
do Andrew Joblon 888 7th Avenue,27th Floor
1691 Michigan Avenue, Suite.445 New York,NY 10019
Miami Beach,FL 33139 (212)894-7090
2. Washington Squared Partners LLC 8. Washington Squared LLC
do Andrew Joblon c/o Andrew Joblon
1691 Michigan Avenue, Suite 445 1691 Michigan Avenue, Suite 445
Miami Beach,FL.33139 Miami Beach,FL 33139
3. IC 601 Washington LLC 9. Turnbridge Miami LLC
c/o Alex Bender do Andrew Joblon
888 7th Avenue,27th Floor 1691 Michigan Avenue, Suite 445
New York,NY 10019 Miami Beach,FL 33139
(212)894-7090
10. PG Washington Squared.LLC
4. IC 601 Washington MGR LLC do Sean Posner
do Alex Bender 1691 Michigan Avenue, Suite 445
888 7th Avenue,27th Floor Miami Beach,FL 33139
New York,NY 10019
(212)894-7090 11. Andrew Joblon
1691 Michigan Avenue, Suite 445
5. IC 601 Promote LLC Miami Beach,FL 33139
do Alex Bender
888 7th Avenue,27th Floor 12. Sean Posner
New York,NY 10019 1691 Michigan Avenue, Suite 445
(212)894-7090 Miami Beach,FL 33139
6. MDF Capital LLC 13. Jarrett Posner
do Alex Bender 1691 Michigan Avenue, Suite 445
888 7th Avenue,27th Floor Miami Beach,FL 33139
New York,NY 10019
(212)8947090
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