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Michael W. Larkin - Emil Stefkov DocuSign Envelope ID:0F59DA19-2DB2-4F0E-A511-01E9A60086B5 PaS\l`e x"l/r A AAA BEACH= RECEIVED Office of the City Clerk 1700 Convention Center Drive MAR 9 2023 Miami Beach, FL 33139 305.673.7411 CITY OF MIAMI BEACH LOBBYIST REGISTRATION FORM OFFICE Oc THE CITY CLERK 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.,#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: Stefkov Emil NAME OF PRINCIPAL (Last) (First) (Middle Name) 81 Washington LLC 108 Seventh Avenue,2nd Floor New York NY 10014 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 212-204-7111 emil@thegroup.nyc PRINCIPAL BUSINESS TELEPHONE NUMBER . CELLULAR TELEPHONE NUMBER EMAIL ADDRESS 0 o Pursuant itgi IJ Code -482(h 1(a): Q principal dimiN corporation partnership,IN caGgaite MD appears I FS]lobs vs CEO I rzfirt Q c(, i'iiiFt( enti ,c2112kgilsped I compensation Q7 - ( llb-e e at ,ram indirecf,�pcontingen,I exp so s ppo o o opposition to an I ern stall regis er with he 6-le as required by its s bsection b t shall no be ,equired to pay any registra for '-ees.. N 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): E. Stefkov tJ • 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 d9;' 645-B17A-4508-848A-2ECA2CA280E2 [ Page 1 of 20 12ECA2CA280E2 I ,III p[93 pF1id5['I II I DocuSign Envelope ID:0F59DA19-2DB2-4FOF-A511-01E9A60086B5 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 81 Washington Avenue (230 1st Street) 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 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 LL1 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): $825.00 per hour e _ Page 2 of 5 I DDocvde ify 113y33AAB2645-B11A-4508-848A-2ECA2CA280E2 Page 2 of 20 22ECA2CA280F2 1111 ISIS211111 I DocuSign Envelope ID:0F59DA19-2DB2-4F0E-A511-01E9A60086B5 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 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 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 X No: 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 mon hs since the elected official(s)whom you provided campaign consulting services was s orn in 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 vs 0 service before lobbying the City Commission at a public meeting. M _Yes X No: Have you provided campaign consulting services to an incumbent member of the City Commission m within the past election cycle?If yes,please list the incumbent member(s)of the City Commission: 0 O N Yes XNo: If yes. were you promised or did you receive economic consideration in e c ange or" campaign xx, — — consulting services, a c w N 00 TO BE COMPLETED BY CITY CLERK'S STAFF ONLY 0 Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# Date Paid. a m Lobbyist Registration Form received and verified by: m F:\CLER\$ALL'\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doe Revised 09/20/2018 N Page 3 of 5 _.3Agee._ � _. _ _ __ DocVerify ID: I wwww do er corn Page j_ Page 3 of 20 —j 32ECA2CA280E2 1 ,III ISM_ 'I II I • DocuSign Envelope ID:0F59DA19-2DB2-4F0E-A511-01E9A60086B5 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 COMVENS TJJQNN:DURING THE REPORTING PERIOD.' Signature of Lobbyist: `' Date 03/08/2023 '-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 and all reporting requ',rert1dby: Signature of Lobbyist: Docusigned b : Date 03/08/2023 �/ �3Lb2bJSSUUEb41U... Signature of Principal: [!�► Date n3/ORr2n23 DDutuB2w8404nA... 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❑ physical presence by means of❑ physical presence or 0 online notarization, or 0 online notarization, this day of 03/08/2023 , 20 , by this_day of n3/0R/2o23 , 20_, by Michael W. Larkin Emil Stefkov NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID _Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION X Personally K X Personally Kn Signature of to gna Public Situr of No Public Diana amos Diana Ramos Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped i� na Ram os 1 Diana Ramos 1 commission#GG 308355 1 Commission#GG 308355 1 Notary Public-State of Florida ( notary Public-State of Florida 1 The; ®y Commission Expires Apr 10,2023 persons: r y Commission Expires Apr 10,2023 6 Exper:° , -I or other _-___:..._ __::_7.-.::.:77273ny 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:3AAB2645-B11A-4508-848A-2ECA2CA280E2 I Page 4 of 20 j 42ECA2CA280E2 J ,III Ws�, II III ■ I www docvenfy com DocuSign Envelope ID:0F59DA19-2DB2-4F0E-A511-01E9A60086B5 MIAMIBEACH 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 0 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. DocuSigned by: 03/08/2023 Lu i B4 s5nD5E8v I0... Signature of Lobbyist Date 0 0 Q' F:\CLER\$ALL\aFORMSILOBBYIST FORMS\Lobbyist Registration Form Revised 03-11-20 REG.doc m ti Page 5 of 5 I DocVerify docvelf 3cAAB2645-B77A-4508-848A-2ECA2CA280E2 Egs,r Page 5 of 20 52ECA2CA280E2 ,III Q IEMT 'I III I • MBF City Hall 1700 Convention Center Or. Miami Beach , FL 33139 305-673-7420 Welcome 005993-0008 Carmen V. 03/09/2023 11:29AM • MISCELLANEOUS Reference 1: MCR431405 NCR OPEN (NCR) 2023 Item: MCR 1.00 it 1,050.00 HCR OPEN (NCR) 1,050.00 • — 1,050.00 Subtotal 1,050.00 Total 1,050.00 CHECK 350.00 Check Number00006533 _ V: •V CHECK a s 350.00 . Check Number00008534 '' • CHECK 350.00 s "54 '-.° D -a�K1 Rim �� o D z,, ;C7 _E_ ,.•; Check Number00008535 , v gig x ,, o w,� 7 c, � . a� c o o 10 „ ? O m D to o m Change due 0.00 „Al. r c 77, •fD <..' o C) o n Paid by: BERCOW RADELL FERNANDEZ LARKIN & i ,� ‘ c, 2 TAPANES PLLC ,a "N s i2- Z w w s 4 ' 41. g aT IIIIIIIIIIIII II II II IIII�IIIIOIall lllllllll'III IIIIIIIIIIIII ° {.., ,s o t l ,. -•.., .si .D' ." wcmrmoa. .muprtu B>f k t'� ,°�' g `z wy S''x" `u. � TN�1 � ,,. s T rJ ittr 11MK tO,a.: 2 4a1.*. ':wrrn5es ..o. a.e • .M w Y,typi,t"rc, ,...«sv:c.••s? a. ..,>g;� € 1 ,5 `,..----me ''''''''' ''''',..1':;,':':::'4',-4'.^,,`,'`'.. ..-4,,,t,--:,:i:,...:-'::::-,,:',,-,:i,,:;;--'.'„,.'0:::),?--.,. . :0;,&-." ..-,'..-6, ,,..-'-9,--,.; -:=!:-: oN . --.4-0455-:::-- Tta- — m „, - .k:, . (6.0 „...,- „,..,...--: , .,. .....„.. .,.....,...„ .. .:„. . ,,,t,r,,,,,,, ,,,, ..‘:-:-..f.,,,,i.-.., 1 r .,;:,,-,... ,,,-. ,:„. ,., „ 1 -,. ,...,........„„,, ........„.....-,,i �.mn..a..� min I e4;1 4" n 0 • • :-::::',';'''.'_...:'• ';.'1,..'::::::::'.,'',.rn.„4:,..c'; %:62 .;::::: :': :'" '::" Thank you for your payment ::: 1X�r MBF COPY1: :. DUPLICATE RECEIPT �'� �" DocuSign Envelope ID:44BE75A2-7317-415A-BD90-87D696577BD5 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. • 81 Washington LLC NAME OF CORPORATE ENTITY NAME AND ADDRESS •%OF OWNERSHIP Emil Stefkov,81 Washington Avenue, Miami Beach FL 33139 100% NAME OF CORPORATE ENTITY NAME AND ADDRESS %OF OWNERSHIP O 0 s a O N U 0 U 0 U c 0 0 co oo 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. 0 0 LL LDocVerify ID:F8005755-61 FD-40FB-9BDD-45CDC6C09542 Page 6 of 9 645CDC6C09542 ,III NINR,I III www.docverify.com