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Michael Larkin- David Martin (Terra Acquisitions Florida CB, LLC) DocuSign Envelope ID:B212F691-057D-42AC-BC5B-1C72F57C2CDA RECEIVED MI AMI BEACH DEC 28 2 Office of the City Clerk 1700 Convention Center Drive CITY OF MIAMI BEACH Miami Beach, FL 33139 ;Fr'rsf .1='-CITY CLERK ERK 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: Martin David NAME OF PRINCIPAL (Last) (First) (Middle Name) Terra Acquisitions Florida CB, LLC 3310 Mary Street, Suite 302 Coconut Florida 33133 PRINCIPAL BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code) 305-416-4556 david@terragroup.com PRINCIPAL BUSINESS TELEPHONE NUMBER CELLULAR TELEPHONE NUMBER EMAIL ADDRESS 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 that entity,without special compensation or reimbursement for the appearance,whether direct, indirect,or contingent,to express support of or opposition to an item shall register with the Clerk as required by this subsection but shall not be required to pay 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): D. Martin • 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 p DOWri ify IL) 8A/5BEBF c,AbA 446 ti8-8tiS2C/E75207 ('age 1 of 18 1B652C7E75207 1111111211111111 DocuSign Envelope ID:B212F691-057D-42AC-BC5B-1C72F57C2CDA 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 5445 Collins 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 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/AJ 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): $825.00 per hour Page 2 of 5 IDocVerify ID:8A75BEBF-CA6A-445C-B868-Bb52C7E75207 www dower ayccmPage 2 of 18 29852C7E75207 pp{{��"p I DocuSign Envelope ID:B212F691-057D-42AC-BC5B-1C72F57C2CDA 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 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 months since the 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. ,h — Yes X_No: Have you provided campaign consulting services to an incumbent member of the City Commission N' within the past election cycle?If yes,please list the incumbent member(s)of the City Commission: a N R, _Yes XNo: If yes, were you promised or did you receive economic consideration in exchange for campaign consulting services? s (0 cl TO BE COMPLETED BY CITY CLERK'S STAFF ONLY Annual Registration fee: [ ]Yes[ ]No Amount Paid$ MCR 0 _Date Paid a Lobbyist Registration Form received and verified by: F:\CLER\BALL\aFORMS\LOBBYIST FORMS\Lobbyist F 1stration Form Revised 09-20-18 REG.doc Revised 09/20/2018 ic Page 3 of 5 ' DocVerity ID: da:ver aom5BE8F-CA6A-445C-8868-B652C7E75207 Page 3 of 18 30652C7E75207 ,yl sgfi1l II • DocuSign Envelope ID:B212F691-057D-42AC-BC5B-1C72F57C2CDA 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 COMPENSATSIONrUURING THE REPORTING PERIOD.' Signature of Lobbyist: �tCua�� Ccu etLt Date 12/22/2023 ----JCoFv?CwcES9A. 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,ietOrtertti°M8-.1 Signature of Lobbyist: r—DocuSfgned by: L``"et� Date 12/22/2023 acer43c..eeJNIOA Signature of Principal: 11 � Date 12/22/2023 9C 3FOa 775444 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 Il(online notarization, or I online notarization, this day of 12/22/2023 ,20_, by this_day of 12/22/2023 ,20 , by Michael W. Larkin David Martin NAME OF LOBBYIST NAME OF PRINCIPAL Produced ID Produced ID �__� F - XPersonally K _ XPersonally Kr S M Signature of Nota ru°t51ic Signature of Notary Public J Diana Ramos Diana Ramos o Name of Notary, Typed, Printed or Stamped Name of Notary, Typed, Printed or Stamped o IIDiana Ramos 1 Diana Ramos Commission#HH 386927 1 Commission#HH 386927 1 Notary Public-State of Florida ► 1 Notary Public-State of Florida 9 My Commission Expires Apr 16,2027 1 My Commission Expires Apr 16,2027 1 The _ _w _,. , _ �..-., _ ,...r�`43 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 I DwocVerifyww do eID:r ry com58E8FCA6A-445C-B868-8652C7E75207 ,I II Page 4 of 18 48652c1E75207 III ISKH DocuSign Envelope ID:B212F691-057D-42AC-BC5B-1C72F57C2CDA MIAMI BEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach, Florida 33139,www.miamibeochfl.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 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. --I�DocuSigned byr pp -1,� l' dL L lf�'�l� 12/22i2023 9C0140 rt003D40A_. Signature of Lobbyist Date F\CLER\SALL\aFORMS\LOBBVIST FORMS\Lobbyist Registration F orm Revised 03-11-20 REG doc Page 5 of 5 DocVenfy ID.8A75BE8F-CA6A-445C-B868-B652C7E75207 ,III)N cool Pape 5 of 18 www docvei i 58652C7E75207 DocuSign Envelope ID:B212F691-057D-42AC-BC5B-1C72F57C2CDA Exhibit A "Disclosure of Interest" "Terra Ac quisitions Florida CB, LLC" David Martin 90% 3310 Mary Street, Suite 302 Coconut Grove, FL 33133 Pedro Martin 10% 3310 Mary Street, Suite 302 Coconut Grove, FL 33133 ri ' DocVerify ID:8A75BE8F-CA6A-445C B8b8 13652C7E75207 Page 6o(18 68652C7E75207 111 gp�,l III www docvenfy.corn IK7 i�iC Miscellaneous Cash Receipt ' ) - CITY OF MIAMI BEACH No. 432736 ❑Cash ❑ Credit Card LJCheck # $ 20 Received of Address For MBF Miscellaneous- MCR-2024 006635-0039 Ebani Th... 12/28/2023 11:15AM MCR OPEN(MCR) Payment Amount: 1,050.00 Office of Finance Director (THIS INFORMATION MUST BE COMPLETED) By Account number: Preparer: Dept: EXT: . r • MBF City Hall 1700 Convention Center Dr. Miami Beach , FL 33139 305-673-7420 Welcome 12/28/2023 04:15PM Ebani T. 006635-0039 MISCELLANEOUS Reference 1: MCR_432736 MCR OPEN (MCR) 2024 Item: MCR 1 @ $1,050.0000 MCR OPEN (MCR) $1,050.00 $1,050.00 Subtotal $1,050.00 Total $1,050.00 CHECK $350.00 Check Number 00009161 CHECK $350.00 Check Number 00009162 CHECK $350.00 Check Number 00009160 Change due $0.00 Paid by: BERCOW RADELL FERNANDEZ, LARKIN 1111111111! 11111111111 II II II 9161 BERCOW RADELL FERNANDEZ,LARKIN&TAvuE$PUG TRUIST : w ...Base 12R8,I0]] w1va1 eo $ s350.00 WN' TMee HuMred PiKYO0On.ne 0/lW........««..........«..«....—.««....«."...«).«.........«—«..«... j Cy DIMi.M Beall eM I" \ «fl7 w .Flal0e ■�)®� Y` ®PSED 9162 BERDOWRMELL FERNANDEZ.LARKIN 6 PM1ESP1LC TRUIST© oaa rwancio.au>t W1]y{a1 10/1e11�3 My TN..Hundred Fay Dolan and 00H00• 1 INE c1y 01 wax B.ex1 � � wwai®.elan— J • MBF City Hall 1700 Convention Center Dr. Miami Beach , FL 33139 305-673-7420 Welcome 9160 }emcowa ULLFERNAND z, TAPANESruc TRW ST �..RM.n1,. wivui +2/2ea023 $ s5 50.000 1 ............._._....^.............. t1 ADO WW cgy a w.M earn MWM,fbid. iiN taS Thank you for your payment MBF COPY DUPLICATE RECEIPT