Michael W. Larkin - IVY MBT Property, LLC 61 4 ,Nt,erfcvc., Ay,
MIAMI BEACH
City of Miami Beach Office of the City Clerk cr,, „� r
1700 Convention Center Drive, Miami Beach, FL 33139 2016 ° `!�r U��
LOBBYIST REGISTRATION FORM i I I� I;t.., ,., ' I i- F
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 Blvd, Suite 850 FL 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State)
(305)374-5300 (305) 377-6222 mlarkin @brzoninglaw.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:
IVY MBT Property, LLC CIO Ivy Realty
NAME OF PRINCIPAL/CLIENT:
IVY MBT Property, LLC C/0 Ivy Realty 102 Chestnut Ridge Road, Suite 204, Montvale, NJ 07645
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(201) 264-6093 ]cosenza @Ivy-Realty.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: Anthony P. DiTommaso Jr., Manager
• IDENTIFY ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION,
PARTNERSHIP OR TRUST: Please see attached.
u SPECIFIC LOBBY ISSUE:
Development approvals and permitting issues related to the properties located at 1674 Meridian Avenue.
Issue to be lobbied(Describe in detail):
III.CITY-- -- __-- - ----- __----- --- -- -- --i
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 eneral 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, City Commission, Development None. X
Boards, Land Use Development Committee None. X
and 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
N/A
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION(DISCLOSE WHETHER HOURLY,FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE:(Required) $550/hour
B) PRINCIPAL'S DISCLOSURE(OF LOBBYIST COMPENSATION): $550/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 lobbying on a present or pending bid for goods,equipment or services,or on a present or pending
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 XNo: 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.
YesXNo: 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.
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 trireme
Signature of Lobbyist:
Signature of Principal/Client:
oz Y �; ����Qo�� 4/et,,g.oe�
y J J
VI. LOBBYIST IDENTIFICATION: / PRINCIPAL IDENTIFICATION:
_Produced ID .............
Form _Produced ID
Form of Identification ,y'..' "°_; Form of Identification
• Personally known(Lobbyist) `Q0o "".. 9(Personally known(Principal)••.., . •,,,.
VII. SIGNATURE AND STAMP OF NOTARY: x 0
Yl 8 =CD
Al ?,4I SEX r3026 .7.)
State of Florida, County of Miami-Dade d m n State ofa,County of Mime
Sworn to and subscribed before me o N p Sworn subscrib d before me ,/
This g j day of AvcU ST ,201 y o This 2Y"day of ,.201•10
v-^r-D-'2-V ? ? Z n ? a C/d��
Signature of Public Notary— ate of Florida ° W ; Z �Signature of Public Notary—State of a /JEk)JRt
Notarization of Lobbyist's signature 3 0 co Notarization of Principal's signature
PATRICTAA BOLE
tt� NOTARY PUBLIC OF NEW JERSEY
TO BE COMPLETgD/AITY CLERK'S STAFF ONLY " ' t8
Annual Registration fee: [ ]Yes["p No Amount Paid$ O• C/0 MCR# O Date Paid (9A �ry,'b
Lobbyist Registration Form receive and verified by: �J "-V.44 j,S l V
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Annual Registration Form.doc Revised 01/22/2014
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
. •
M1AM,
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: 305.673.741 1 ,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 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-CIV-4
Signature: Date:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form.doc
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Ivy MT Property, LLC
Ownership Chart
As of August 25, 2016
Ivy Realty Fund IV, L.P. 10%+Owners of Ivy Realty Fund IV,L.P.
102 Chestnut Ridge Road Ellipse Holdings, LLC-20 Horseneck Lane,
Montvale, NJ 07645 Greenwich,CT 06830 42.7% (1)
Texas Christian University-2800 5.
• University Drive, Fort Worth,TX 76129 11.4% (2)
Federal Insurance Company-15 Mountain
100% View Road, Warren, NJ 07059 22.8% (3)
Total 10%+Owners 76.8%
Ivy MBT Holdings, LLC 76 Various Individuals,Trusts and LLCs 23.2%
102 Chestnut Ridge Road
Montvale, NJ 07645 Total 100.0%
100%
Ivy MBT Property, LLC
102 Chestnut Ridge Road
Montvale, NJ 07645
1 -
1674 Meridian Avenue, Miami Beach,Florida
(1) Ellipse Holdings, LLC is a pass-thru investment holding company. Majority owners are Stephen
Friedman (35%) of NY,NY and Charles Davis(35%)of Greenwich,CT.
(2) TCU is a 501(C)(3)Tax Exempt Organization
(3) Federal Insurance Company is a 100%wholly owned subsidiary of Chubb Ltd(NYSE:CB)
5.\C\NP Constn,ct.onk167a Meridian AVonue\Cahibd 8 to Application 8/26/2016
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