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Michael W. Larkin - Ophira Cukierman DocuSignEnvelope ID:F0B4E301-B536-4F9D-A4C6-D097DC392BD4 RECEIVED DECEIVED MIAMI BEACH JAN 31 2023 Office of the City Clerk 1700 Convention Center Drive Miami Beach, FL 33139 CITY OF MIAMI BEACH 305.673.7411 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 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 "ri/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 300,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: Cukierman Ophira NAME OF PRINCIPAL (Last) (First) (Middle Name) 1688 Property Owner,LLC 59 Greenacres Avenue Scarsdale NY 10583 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) • 917-860-0072 ocukierman@gmail.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS b Pursuant to City Code Section 2-482(h)(1)(a): a principal of any corporation,partnership, or other entity who appears as a lobbyist on behalf of tha, entity,without special compensation co reimbursement for atin- appearance,whether direct,indirect,co contingent,to express support of or opposition t. an�item register with1tater rk as reguiredl ittiis subsectio ibutritiMI nottbe required to pay any regigt atii fees: 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): O. Cukierman • 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): Please see the attached. Page 1 of 5 EB1-058C-442E-8429-B977E9DE4D22 1 Page 1 of1B JB977E9DE4D22j 1111 ,r�ItS11111 DocuSign'Envelope ID:F0B4E301-B536-4F9D-A4C6-D097DC392BD4 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&Permitting 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 1709 Jefferson 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 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 Land Use&Sustainability Committee 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 b 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 W 0 u n 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): U $825.00 per hour Page 2 of 5 g DocVerify ID:B44CAEB1-058C-442E-8429-B977E9DE4D22 Page 2 of 18 28 gill rk oitii977E9DE4D22 I www docvenfy com DocuSign.Envelope ID:FOB4E301-B536-4F9D-A4C6-D097DC392BD4 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 for 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 Aqreement with the City or application for change of zoning 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 organization for the purpose of requesting a grant without special compensation or reimbursement for the appearance. _Yes XNo: Are you providing only scientific, technical or other specialized information; appearing as a representative 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 2-491(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.See Section 2-491 for more information. —Yes XNo: 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 yes, has it been less than 12 months since the elected official(s)whom you provided campaign. consulting services was sworn ini 6) Pursuant to City Code Section 2-482(a)(4)a.,a lobbyist who has within the past election cycle provided campaign consulting g services to an incumbent member of the City Commission(which lobbying activity is not otherwise prohibited by Code section 00 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 XNo: 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 X No: If yes, were you ar'raised or did you receive economic consideration in exchange for campaign — consulting services w TO BE COMPLETED BY CITY CLERK'S STAFF ONLY N , • Annual Registration fee: ( J Yes[ J No Amount Paid$ MCR# Date Paid co • Lobbyist Registration Form received and verified by: F:\CLER\SSALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Revised 09/20/2018 U Page 3 of 5 DocVerify ID:B44CAEB1-058C-442E-8429-B977E913E4D22 L Page 3 of 18 3B977E9DE4D22 111I III Q}i.www docveri com DocuSign,Envelope ID:FOB4E301-B536-4F9D-A4C6-D097DC392BD4 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 COM3ENSAZION:DURING THE REPORTING PERIOD' Signature of Lobbyist: v `' Date 01/30/2023 \-3262b35S1)96410... 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-aMM'lirmpporting requirements. Signature of Lobbyist: v `' DocuSigned by: Date 01/30/2023 `—3Lb1ti0S0U'1ttl410... COrL , Cule Signature of Principal: raatt'Date 01/30/2023 U241-t21-1t1034t4... VII. NOTARY SIGNATURE AND SEAL: LOBBYIST: PRINCIPAL State of Florida State of Florida County of: Miami-Dade County of: Miami-Dade 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 El online notarization, or EI online notarization, this day of nvsnt n, .20 , by this_day of nimn/2n2s ,20_, by' Michael W. Larkin Ophira Cukierman NAME OF LOBBYIST NAME OF PRINCIPAL Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION X Personally Know --- _Personally Know Sil--- I i Signature of Notary Public Signature of.Notary Public Diana Ramos Diana Ramos 0 h Name of Notary, Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped o Dana Ramos 4 Diana Ramos o Commission#GG 308355 4 I eommIssIon#GG 308355 1 Notary Public-State of Florida I {Votary Public-State of Florida 1 a igy Commission Expires Apr 10,2023 I 1 fitly Commission Expires Apr 10,2023 1 1 The o I, persons: rz _ _ __ _ _ . __________ _ _ 1 Expen wiuiessda wiw piuvlue ui n ny aucinuulu, te1:11111tail or other speclaliz=.................... .............. ...r.................. y,.,'any person who 6 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 Lu the appearance. 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