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Michael W. Larkin - Daniel Hertzberg t DocuSign Envelope ID:D6C65B81-C767-4F34-894D-1F8OCB203EA6 nECEEVED /\/\I,41\/\I BEACH A� 16 2023 Office of the City Clerk 1700 Convention Center Drive Miami Beach,FL 3139 cmFFIC O 305.673. OE OFMHEMIN 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 "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: Hertzberg Daniel NAME OF PRINCIPAL (Last) (First) (Middle Name) 1420 West 22 Street Miami Beach Florida 33140 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-505-1950 danny@jillszeder.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS (OW @a29.9airm2-482 4)) 1 GJ pri cipal(obi /corporat on,Ltaiaced41,Cf? appears iM3 a lobbyist CIE L2ikag d1 Qag g .,nntytity, itl*out spec al compensat on ctfreim_,b rseme t for(12 appearar, e,whether dire indirect ce&abiwidl,ll ex.ress support of or opposition t Ma item shall register w ththe Clerk as equiredlntiis subsect on b't�atFshall not{be required to pa any registration 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): 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): n/a a • 0 Page 1 of 5 aid,S'..01470-D9A1-4BC8-BC07-A895AF196FF8 ,III N ,I II I Page 1 of 5 1A895AF196FF8 FEEEii DocuSign Envelope ID:D6C65B81-C767-4F34-894D-1F80CB203EA6 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 1420 West 22 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 LL Co 0, LL V. DISCLOSE RATE AND AMOUNT OF LOBBYIST COMPENSATION — Be Specific. (Note that a 06 contingency fee is prohibited pursuant to City Code Sec. 2-485.3): $825.00 per hour Page 2 of 5 DocVerify ID:80550470-D9A1-4BC8-BC07-A895AF196FF8 I Page 2 of 5 r 2A895AF196FF8 I ,III p�y�, 'I III www.docverify.com S� " DocuSign Envelope ID:D6C65B81-C767-4F34-894D-1F80CB203EA6 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 X No: 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 x No:• 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 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 x No: 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 X No: If yes, has it been less t an 12 mo the since th- elected official(s) whom you provided campaign consulting services was sworn 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 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: 0 0 Yes X No: If yes, were you promised or did you receiv- economic consideration in exchange for campaign consulting servicesr. 03 TO BE COMPLETED BY CITY CLERK'S STAFF ONLY • Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR# - Date Paid ▪ Lobbyist Registration Form received and verified by: • F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form Revised 09-20-18 REG.doc Revised 09/20/2018 Page 3 of 5 DocVerify ID:80550470-D9A1-46C8-BC07-A895AF196FF8 Page 3 of 5 ' 3A895AF196FF8 ,III QEgY,� ,I III 1 www.docverify.com 03afT DocuSign Envelope ID:D6C65B81-C767-4F34-894D-1F8OCB203EA6 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 CO AVVON DURING THE REPORTING PERIOD.1 Signature of Lobbyist: lug a�,t �• itAtitn. Date 03/02/2023 CDFF0F6E5B38470... 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 C aridialidreporting requirements. tttSignature of Lobbyist: kid' ' �' CIA n„m„ci0"ad hy. Date 03/02/2023 wrrurotbliM4ro... Signature of Principal: V 'Fite 03/02/2023 7AB4558 E8D9445... 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 0 online notarization, or 0 online notarization, this day of 03/02/2023 ,20_, by this day of 03/02/2023 ,20_, by Michael W. Larkin Daniel Hertzberg NAME OF LOBBYIST NAME OF PRINCIPAL _Produced ID Produced ID FORM OF IDENTIFICATION FORM OF IDENTIFICATION _Personally Krr •1 _Personally Kn1 Signature_ofaNaotar public Signat JV Ta o blic aos Name of Notary,Typed, Printed or Stamped Name of Notary,Typed, Printed or Stamped m ae.�n Diana Ramos Diana Ramos LL Commission#GG 308355 Commission#GG 308355 a, N Notary Public-State of Florida Notary Public-State of Florida Commission Ex Tres A r 10,2023 tJy Commission Expires Apr 10,2023 1 The l y p p g persons: m rawna.,vuzzasaz aor<.•s, Ex er:w: °'"''°` I or other specialized information or testimonyinpublic meetings; person who P .,r��•��, � P 9 any • 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:80550470-D9A1-4BC8-BC07-A895AF196FF8 Page 4 of 5 4A895AF196FF8 www.docverify.com ,III ,I III v DocuSign Envelope ID:D6C65B81-C767-4F34-894D-1F8OCB203EA6 • MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov Office of the City Clerk Rafael E. Granath), 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. 0 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 $500.00 pursuant to Section 2-482 of the Miami Beach City Code. LL li DocuSlgned by: L r w. ui 03/02/2023 CD P016C6g38970... Signature of Lobbyist Date • U ti F:ICLERI$ALL1aFORMSILOBBYIST FORMStLobbyist Registration Farm Revised 03-11-20 REG.doc Page 5 of 5 DocVerify ID:80550470-D9A1-4BC8-BC07-A895AF196FF8 Page 5 of 5 5A895AF196FF8 ,III 'I III www.docverify.com y�jA�.,0 docv'erify' - �$ o� 9CVER� Lobbyist Registration Form - MWL - D. Hertzberg.- executed.pdf DocVerify ID: 80550470-D9A1-4BC8-BC07-A895AFI 96FF8 Created: March 02, 2023 11:05:47 -8:00 Pages: 5 Electronic Notary: Yes / State: FL This document is a DocVerify VeriVaulted protected version of the document named above.It was created by a notary or on the behalf of a notary,and it is also a DocVerify E-Sign document,which means this document was created for the purposes of Electronic Signatures and/or Electronic Notary.Tampered or altered documents can be easily verified and validated with the DocVerify veriCheck system. Go to www.docverify.cbm at any time to verify or validate the authenticity and integrity of this or any other DocVerify VeriVaulted document. \. • E-Signature Summary E-Signature Notary:Diana Ramos(dra) March 02,2023 11:07:44-8:00[D6A8DAAADE23][74.220.90.117] dramos@brzoninglaw.com I 11111 r i. . , , . ,.. 111111I IIII IIIIII IIII IIIIII IIIII IIIII IIIII IIIII IIIII IIII IIIII IIII IIII • . . DocVerify documents cannot be altered or tampered with in any way once they are protected by the DocVerify VeriVault System.Best viewed with Adobe Reader or Adobe Acrobat. All visible electronic signatures contained in this document are symbolic representations of the persons signature,and not intended to be an accurate depiction of the persons actual signature as defined by various Acts and/or Laws. I DocVerify www.do elrifycom50470-D9A1-4BC8-BC07-A695AF196FF8 ,IIIII III Generated Cover Page A895AF196FF8 • • City Hall 1700 Convention Center Dr. Miami Beach , FL 33139 305-673-7420 Welcome • 006004-0005 Carmen V. 03/16/2023 11 :55AM MISCELLANEOUS Reference 1 : MCR431412 MCR OPEN (MCR) 2023 Item: MCR 1 @ 1,900.00 MCR OPEN (MCR) 1 900,00 { • ° 1 900.00 „o iu •r a�;�.�.� - m .;, (D * Z 3 .. Ua to 0 _ Subtotal "' 4 `� T ;o. = fi� :n �� `z n. 1,900.00 ,-7-� z . .O = c, Sii r ' r,, O ❑ g ,E Total 1,900.00 - � ,` c CHECK D < o 7 A - ;n t. 850.00 _ �, oo . Check Number00008564 m 'h CHECK 1,050.00 • � o N �` . _ o Check Number00008565 Changedue 0.00 h .i !! W. ,� -°n': .> . n Paid by: BERCOW RADELL FERNANDEZ LARKIN O S TAPANES PLLC � � c� ° IIIIIIIIIIIII Illlllllllllllllllllllillllllllllllllllllllllllll r � { � � ��fr4 � ,• wr+cw umvAumw3Rtc Q�04 _ c 2 y mcYa�.rnilx 7R4 a4'ilisr© NW 14=ofe r ' . .euY+WkM�w............w..rw..........w..... ;UM b $ 5,�y 'fly. .. A w 6W1C4 .. � '"Y3 mvroerurrraux f r ..__I-Z - 4, °ram �,�� 3� ' * rmrzrrwneururrn wrw,ruerrua �. sbd6 ° u.wan.. num.+� vrs tra �l Oin 4rF09MWt1144'8 ( `7 ej „xi f D p ? N FliThank you fir your payment �" o C1'STOMER COPY I