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Michael W. Larkin - New Hosco Beach, LLC —)3c kC RECEIVED 1\A I AI v ' B[AC H Office of the City Clerk 1700 Convention Center Drive OCT 220 Miami Beach, FL 33139 305.673.7411 CITY OF MIAMI BEACH OFFICE OF THE CITY CLERK 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 committeei 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 section 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 it Tapanes, PLLC 200 South Biscayne Blvd., Ste. 850 Miami,Florida 33131 LOBBYIST BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) (305) 374-5300 .i mlarkin@brzoninglaw.com LOBBYIST BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS II. PRINCIPAL INFORMATION: Bastidas Marco NAME OF PRINCIPAL (Last) (First) (Middle Name) New Hosco Beach,LLC 1313 Ponce De Leon Blvd.,Suite 301 Coral Gables,FL 33134 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 786-703-7704 marcobastidast@ritofa.com.ec PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS Pursuant (c :o- Section 2-482,hr)( Dal A p I cip I du corporation, Q artners 'p,P other CAV diaD a o pears En O lobbyist Grua i• h. t 1 tha NIVE,without special compensation offeimbun ement for Op appearance, he her&Oa I - indirect,CP contingent, C '9 V•o l2?oe o osition to -MRI II 1]D Mph are 0 uired n- ' sllbsect'on } in be rev uired it51U9 an .re a istration itga If the principal is a Corporatioh, Partnership or Trust, the following information MUST be provided pursuant to City Code Section 2 1482(c): • NAME OF CHIEF OFFICER, PARTNER,OR BENEFICIARY(if none,write N/A): • NAME OF ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY,A 5%OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION; PARTNERSHIP OR TRUST(if none,write N/A): See Attached. Page 1 of 5 reifjor 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 7835 Harding Avenue 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. Full Name of Individual and Contractual Relationship (If yes, explain) YES NO Title of Person to be Lc,bbied Staff for the Planning&Buildingl 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. List any Business, Financial, Familial or Professional Relationship, or other relationship giving rise to an appearance of impropriety (if none,write N/A): None 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 per hour Page 2 of 5 The following six(6)questions MUST be answered: 1) Pursuant to 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 Ifor goods,equipment or service? 2) Pursuant to 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 zoninq map designation or change to the City's Future Land Use Map? 3) Pursuant to City Code Section 2.482(h), any person (except those exempt from the definition of "lobbyist" as set forth in Section 2-481)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 city clerk as required by this section, but shall not be required to pay any registration fees. _Yes XNo: Are you representing a not-for-profit corporation or entity without special compensation or reimbursement? 4) Pursuant to City Code Section 2-481, 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 iorganization for the purpose of requesting a grant without special compensation or reimbursement for the appearance. _Yes x No: Are you providing only scientific, technical or other specialized information; appearing as a representative l of a neighborhood association without special compensation or reimbursement or representing a not-for-profit based organization for the purpose of requesting a grant without special compensation or reimbursement? 5) Pursuant to City Code Section 2J491(1), no campaign consultant shall lobby the City Commission for a period of 12 months following the swearing in of any elected official(s) for whom the campaign consultant provided campaign consulting services within the past election cycle. Seel Section 2-491 for more information. _Yes XNo: Have you provided campaign consulting services to an incumbent member of the City Commission within the pasty election cycle?If yes, please list the incumbent member(s)of the City Commission: _Yes XNo: ti�.es hWas, e n less an 2 mon hs 'r, a he lected official si h•m .ou •rovided camo ai n consulti,q se.:Ices was sworn 'far) 6) Pursuant to City Code Section 2-482(a)(4)a., a lobbyist who has within the past election cycle provided campaign consulting services to an incumbent member of the City Commission (which lobbying activity is not otherwise prohibited by Code section 2-491) shall disclose such particular service on his/her lobbyist registration form and shall orally disclose such particular service before lobbying the City Commission at a public meeting. —Yes X—No: Have you provided campaign consulting services to an incumbent member of the City Commission within the past election cycle?If yes,please list the incumbent member(s)of the City Commission: Yes XNo: If es ere DU •rami o 'or did io ie©elve ..annom icconsi•oration'in exchan•e for cam•ai•,n onsultiriq s rvi�'Cres? — — — i TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ ]'No Amount Paid$ MCR# 41/6 3.9 Date Paid l? Lobbyist Registration Form received and verified by: i'dC5„ w=1j" �'�t =' F:\CLER\BALL\aFORMS\LUBi3YIST FORMSNLobii,vistR RegistrationiFormlRevised 09-20-A8:REG:doe Revised 09/20/2018 Page 3 of 5 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 Tb LOBBY. A STATEMENT SHALL BE FILED EVEN IF THERE HAS BEEN NO EXPENDITURE OR COMPENSATION DURING THE REPORTING PERIOD.' Signature of Lobbyist: Date I do solemnly swear or affirm that all o 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: Date Signature of Principal: ' /' / Date /12 '09' -OZ-O I VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of Florida State of rkei /GLJ County of: Miami-Dade County of: 0/a/771- acve. Sworn to (or affirmed)and subscribedlbefore me, Sworn to (or aaf frrmed) and subscribed before me, by means of 0 physical presence by means of R'physical presence or 0 online notarization, or❑ online notari do ,, this day of ,20_, by this 79 day of cc/obeg_i ,202?by Michael W. Larkin :nc� A. /V1 zrq NAME OF LOBBYIST NAME OF INCIPAL _Produced ID Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION _Personally Known `✓ Personally Known / e&lo/ $ Signature of Notary Public Signature of Notary Public Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped (NOTARY SEAL) (NOTARY SEAL ; JEANNIE B.CLAN° ,,1 MY COMMISSION#GG 329478 .r".Z97 EXPIRES:May 23,2023 't4'o vl? Bonded lbw Notary Public UndenwIter$ I 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 vuUUOtyn CI IVCIUpC UJ. INOV/rtrr-C.,or-9ot,4-ouDol, 1 I LrzoomrrHr 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.' Docuslgna'd by: 10-9-2020 Signature of Lobbyist: %1 Date 32B2B355D9E0410... I do solemnly swear or affirm that all o'II f the foregoing facts, statements, and disclosures in this form are true and correct, and that I have read or am familiar wish the provisions contained in Chapter 2, Art. VII, Division 3, entitled "Lobbyists" of the Miami Beach City Code and all reporting requirements. —DocuSignod by: Signature of Lobbyist: s Date 10-9-2020 —32B2B355D9E0410... Signature of Principal: 1 _ __ Date VII. NOTARY SIGNATURE AN 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 0 physical presence by means of 0 physical presence or® online notarization, or 0 online notarization, this 9 day of October ,2020, 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 Persorplly Knnuura,_.... _Personally Known 1q1---- Signature of Notary Public Signature of Notary Public Diana Ramos Name of Notary_Typed,4 Printed orStamped Name of Notary,Typed, Printed or Stamped Diana Ramos ',Diana #GG 308355 (NOTARYSEAL) Notary Public-State of Florida My Commission Expires Apr 10,2023 0 1 The a — 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 vucuaiyn CIvewpe iu.aaMoacou-rcuo-4i13l.-110o0-i I CoL.voaCC io /11 BE AC Fl 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: Gregory Fontela 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 commencing October 1 of each year, and the fee for such annual registration shall be $500.00 pursuant to Section 2-482 of the Miami Beach City Code. ,—DocuSlgned by: 0 10-9-2020 —B1980729242A40B... Signature of Lobbyist Date F:ICLERI$ALL1aFORMSILOBBYIST FORMS\Labbylst Registration Form Revised 03-11-20 REG.doc Page 5 of 5 Page 6 of 8 DISCLOSURE OF INTEREST CORPORATION,PARTNERSHIP OR LIMITED LIABILITY COMPANY If the property that is the subject of the application is owned or leased by a corporation, partnership or limited liability company, list ALL of the owners, shareholders, partners, managers and/or members, and the percentage of ownership held by each. If the owners consist of one or more corporations, partnerships, trusts, partnerships or other corporate entities, the applicant shall further disclose the identity of the individual(s) (natural persons) having the ultimate ownership interest in the entity. NEW HOSCO BEACH, LLC. NAME OF CORPORATE ENTITY NAME AND ADDRESS %OF OWNERSHIP New Hosco Investments Ltd. 100 Omar Hodge Bldg., 2nd Floor, Wickham's Cay 1 , Road Town, Tort British Virgin Islands NAME OF CORPORATE ENTITY NAME AND ADDRESS %OF OWNERSHIP If there are additional corporate owners,list such owners, including corporate name and the name,address and percentage of ownership of each additional owner,on a separate page. We are committed to providing excellent public service and safety to all who live,work,and ploy in our vibrant tropical,historic community. POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That We, Marco A. Bastidas Yunes and Marco A. Bastidas Teran, Collectively and as Managers of NEW HOSCO BEACH, LLC.,a Florida limited liability company, have made, constituted and appointed, and by these presents do make, constitute and appoint, JENNIFER A. MARQUES, lawful attorney for me and in my name, place and stead, and more specifically in connection with the construction of the property to wit: 7835 Harding Avenue, Miami Beach, FL 33141 to execute any applications, letters, affidavits, and any other document necessary to effectuate said construction and building, giving and granting unto, JENNIFER A. MARQUES full power and authority to do and perform all and every act and thing whatsoever requisite and necessary to be done in and about the premises as fully, to all intents and purposes, as I might or could do if personally present, hereby ratifying and confirming all that JENNIFER A. MARQUES shall lawfully do or cause to be done by virtue hereof. WITNESSES: NEW 'SCO BEACH, LLC, - ' orida limit=d liabilit. compa y ; BY: Print: j ti _ 't\�L MAS A :ASTIDAS YUNES,;Individually and as Man.ger d� l Print: , �_ >�V BY: ` ` "�� F' MARC• -A :A ILTAS TERAN, '.•ividually and as anager lillab �.s• ��,"' s emaridez /;IA Notary' • State of Florida •: y My Comm.Expires 3512023 ii:e Commission No.424398 3 f 6/20 I iscellaneous Cash Receipt CITY OF MIAMi?BEACH No� 42703, ' ': .,, 1 ,',.,' '' '.::::3 D Cash C1 Credit Cards C,Check# ptv�dof Miscellaneous mcrcas ?+21 � ' n shier mcroas P '*.� Payment Amount 700.00 �, a ' (THt3;INRtfRMAT)ON MUST BE COMPLETED) OMc. of Rnsnci►olnc#or ., ' ,.. `�, ky r • ACCOWI Il.m r t t"t t �' E ) 1_ --t '17-1 >" °? _°' '\ `` r.,., .,iw..,�....,,.... ",......»_w.+w.+..uJ._....,. � » 1Yi : E ,,, ..a�\ " , .,' ,- ,, .. ,.& ..0 .`�a +..ia...�c.:;.t� . m, . .e a 'z ^`