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Michael Larkin - James Knall ?ox t .° reve DocuSign Envelope ID:83F5355F-37C1-42F6-ABA9-D818A45BF4EF RECEIVED M I AiV I E C HMAY 14 2020 Office of the City Clerk 1700 Convention Center Drive CI1V OF MIAMI BEACH Miami Beach, FL 33139 OFFICE OF THE CRY CLERK 305.673.7411 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 City Code Chapter 2, Article VII, Division 3, entitled"Lobbyists," for additional information. Instructions: Please complete all sections of this form and submit the completed form,with the applicable fee, to the Office of the City Clerk. If you need more space to complete an answer, use a separate sheet(s) of paper. If you have nothing to report in a particular section, you must write "none" or "n/a" in that section. Any change to any information originally filed, or any additional City Commissioner or personnel who are also sought to be lobbied shall require that the lobbyist file an amendment to the registration form. The lobbyist has a continuing duty to supply information and amend the forms filed throughout the period that the lobbying occurs. Separate registration forms shall be required for each principal represented on each specific issue. I. LOBBYIST INFORMATION: Larkin Michael W. NAME OF LOBBYIST (Last) (First) (Middle Name) Bercow Radell Fernandez Larkin&Tapanes, PLLC 200 S. Biscayne Blvd.,Suite 850, Miami, FL 33131 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 374-5300 mlarkin@brzoninglaw.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Knall James NAME OF PRINCIPAL (Last) (First) (Middle Name) ILR LLC 802 W Dilido Drive Miami Beach Florida 33139 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) jamesknall@gmail.com oo PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS oo• AMMER go My Code EagEift 2-48201(1n A principal dl Effei corporation, partnership.(•p cagy Cay Tan.®A . 63a lobbyist @E klieffif dad MGM 4sialE special co pensatia+()Tait:11E2mM forft 1t1 appearance,Stailar direg.indirect.OP conting-at,(17 w•• m(ap o•*coition(It* • naggidtrAMMozzaD the @Me@ MOW WOO O • • Ii€s ni- rilD m QU re d istrat o fes, O If the principal is a Corporation, Partnership or Trust, the following information MUST be provided • pursuant to City Code Section 2-482(c): • NAME OF CHIEF OFFICER,PARTNER, OR BENEFICIARY(if none,write N/A): ,___12 L Ck �cS \4i \ • NAME OF ALL PERSONS HOLDING,DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP AI'NTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST(if none,write N/A): �N1L� "' L-- 0 6 Page 1 of 5 1JionaRanu 3-1C1384ACD5B8 I 11C1384ACD5B8 ,IIICom'EgralIIII s.,�opxi�aa,a,„ Page 1 of 6 DocuSign Envelope ID:83F5355F-37C1-42F6-ABA9-D818A45BF4EF III. ISSUE TO BE LOBBIED: Describe with as much detail as is practical, including but not limited to a specific description where applicable of a pending request for proposal, invitation to bid, or public hearing number. Development Approvals &Planning Issues,including but not limited to the Historic Preservation Board, Design Review Board,Planning Board, Board of Adjustment, Land Use Development, City Commission, and any City Workshops or Committees,if necessary,relating to the property located at 802 W Dilido Drive in Miami Beach,Florida. IV. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(a)(4), list the City Commissioner or City personnel sought to be lobbied, and whether the lobbyist has entered into any contractual relationship (paid or unpaid) with said City Commissioner or City personnel from 12 months preceding such commencement of service with the City to the present date, stating the general nature of the subject contractual relationship. I Full Name of Individual and Contractual Relationship (If yes, explain) YES NO Title of Person to be Lobbied Staff for the Planning &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 ,000 be lobbied as identified on the lobbyist registration form filed. List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an N appearance of impropriety (if none,write N/A): None U V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note that a contingency fee is prohibited pursuant to City Code Sec. 2-485.3): $675.00 p/h 0 U Page 2 of 5 DocVerify ID:C13C362C-0336-4598-8853-1C1384ACD568 Page 2 of 6 21C1384ACD5B8 ,III � 'I III www.docverify.com VI. SIGNATURES UNDER OATH: ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, FOR THE PRECEDING,CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO EXPENDITURE OR COMPENSATION DURING THE REPORTING PERIOD.1 Signature of Lobbyist: Date I do solemnly swear or affirm that all of the foregoing facts, statements, and disclosures in this form are true and correct, and that I have read or am familiar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of the Miami Beach City Code and all reporting requirements. Signature of Lobbyist: Ali Date .442,4-9167 ' ie— r kl'tt Signature of Principal: Date 14)9/6 VII. NOTARY SIGNATU Illy AND SEAL: LOBBYIST: PRINCIPAL of �d� State of State of n , • /, • County of: County of: �' 494' ; _ Sworn to (or affirmed) and subscribed before me, Sworn to (or aff ed) and subscribed before me, le *,,,•' �I by means of 0 physical presence by means of Yphysical presence or 0 online notarization, or 0 o ne notari do , g ro o this dayof , 20_, bythis.` "lda of C► 1 , � Y , 20_, by � sm � • � �' (;) Michael W. Larkin James Knall3, O . a _. z. NAME OF LOBBYIST NAM OF PRINCIPAL P.8 : o w r _Produced ID _Produced ID ' Dt-K640153'L8•1co-d W FORM OF IDENTIFICATION FORM 0' IDE TIFICATION 1 _Personally Known _Personally Known / (a •. �' . 1A�„i • I Signature of Notary Public Signature of Notary Publi [ a ci Name of Notary, Typed, Printed or Stamped Name of N - --- !..j).0,. DIANA AMOS (NOTARY SEAL) (NOTARY :ie`� ,~ c`Q #GG 089 5 2g 4 i }Igop ��•,c, _ I. �J L1L ',) . • ' 0. 1. 1 The term "lobbyist” specifically excludes the following persons: Expert witnesses who provide only scientific, technical or other specialized information or testimony in public meetings; any person who • only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance, whether direct, indirect or contingent, to express support of or opposition to any item; and any person who only appears as a representative of not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for the appearance. Page 4 of 5 DocuSign Envelope ID:83F5355F-37C1-42F6-ABA9-D818A45BF4EF VI. SIGNATURES UNDER OATH: ON FEBRUARY 28 OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE OFFICE OF THE CITY CLERK A SIGNED STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION RECEIVED, FOR THE PRECEDING CALENDAR YEAR WITH REGARD TO THE SPECIFIC ISSUE ON WHICH THE LOBBYIST HAS BEEN ENGAGED TO LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO EXPENDITURE OR COMPENSA N,D RING THE REPORTING PERIOD.1 Signature of Lobbyist: C/ v Date 04/29/2020 32B2B355D9E6410... I do solemnly swear or affirm that all of the foregoing facts, statements, and disclosures in this form are true and correct, and that I have read or am familiar with the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of the Miami Beach City Code apd_gU- reporting requirements. Signature of Lobbyist: V Date 04/29/2020 Signature of Principal: Date VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State;of Florida State of County of: Miami-Dade County of: Sworn to(or affirmed) and subscribed before me, Sworn to (or affirmed) and subscribed before me, by means of D physical presence by means of 0 physical presence or Cgl online notarization, or 0 online notarization, this 29 day of April , 2024 by this day of , 20_, by Michael W. Larkin NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION X Personally Known _Personally Known 0 Signature of No� .. Signature of Notary Public Diana Ramos Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped m 1 Diana Ramos (NOTARY SEAL) 0 1 Commission#GG 308355 Notary Public-State of Florida ({ Icy Commission Expires Apr 10,2023 1 The/ g persons: • Expert witnesses who provide only scientific, technical or other specialized information or testimony in public meetings; any person who only appears as a representative of a neighborhood association without compensation or reimbursement for the appearance, whether direct, indirect or contingent, to express support of or opposition to any item; and any person who only appears as a representative of not-for-profit community based organization for the purpose of requesting a grant without special compensation or reimbursement for the appearance. Page 4 of 5 DocVerify ID:C13C362C-0336-4598-8853.1C1384ACD568 Page 5 of 6 I 51C1384ACD5B8 ,III 'I II I www.docverify.com DocuSign Envelope ID:83F5355F-37C1-42F6-ABA9-D818A45BF4EF AA.1AMIBEACH City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov Office of the City Clerk Rafael E. Granado,City Clerk CityClerk@miamibeachfl.gov Tel: 305.673.7411, Fax: 305.673.7254 NAME OF LOBBYIST: Michael W. Larkin 1) LOBBYIST FEE EXPENDITURE AND COMPENSATION STATEMENT Pursuant to City Code Section 2-485(d), the City Clerk shall notify any lobbyist (or principal) who fails to file timely a Lobbyist Fee Expenditure and Compensation Statement (Statement). In addition to any other penalties that may be imposed as provided in Section 2-485.1, a fine of $50.00 a day shall be assessed for Statements 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. I hereby acknowledge that on February 28 of each year, I shall submit to the City Clerk a signed Statement under oath listing all lobbyist expenditures, as well as compensation received, for the preceding calendar year with regard to the specific issue on which I have been engaged to lobby. 2) LOBBYIST WITHDRAWAL Once an issue I have registered to lobby has concluded or I am no longer lobbying on that issue, I shall immediately file a Notice of Withdrawal with the Office of the City Clerk. 3) ANNUAL LOBBYIST REGISTRATION FEE I understand annual registration of all lobbyists shall be required for each 12-month period N commencing October 1 of each year, and the fee for such annual registration shall be $500.00 pursuant to Section 2-482 of the Miami Beach City Code. o DS Lr9 4/29/2020 cc Signature of Lobbyist Date m v co M O cU., F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc 5 Page5of5 DocVerify ID:C13C362C-0336-4598-8853-1C1384ACD5B8 Page 6 of 6 I 61C1384ACD5B8 ,III Ems"II www.docverify.com QSa' r l' Miscellaneous MiscellaneousCas , Receipt ; 1 CITY OF MIAMI B C - . ti . . .. s 1. ,. , n ; o.426615 � , t D Cash t 0 Credit°Card= t Che k# i . . . $ OV:.:1 k{ 20-`20 »�Fd , ( ! ( ( lc.: ,.) . /' 7 .:: 1)y� 1 .. P -Rema celianeofir3 'ot.K .U2u- :" � A' . '`.-' 4 ,4 4 / 1 j t 'IIAddresjonin n��•aLn ni.?A147�g� 1,a sri1--t7 k../ i ) ; y :,/./1!,- c: , CR OPEN %,----,, (- 0 . L. i r .V "( 1 . . Payment wn-rount 700.�{J. t 426615 , , . 1 (THIS INFORMATION MUST BE COMPLETED) . ' Office of Finance`Director ' •- y Accent Number: (, 1• 1 (. t - 1. Preparers Dept: EXT: 1