Michael Larkin/Collins Hotel Associates, LLC
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRA nON 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, dedsion, recommendation of the
Oty Manager or any dty 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 in dudes the prindpal as well as any employee engaged
in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
Larkin
Michael
W.
(Last) (First)
200 S. Biscayne Blvd., suite 850 Mia
(Number and Street) (Oty) (State)
305-377-6222 mlarkin@brzoninqlaw.com
FAX NUMBER: EMAIL:
(M.I)
NAME OF LOBBYIST:
Bercow & Radell
BUSINESS NAME AND ADDRESS
305-377-6231
1
TELEPHONE NUMBER:
L LOBBYIST RETAINED BY:
Collins Hotel Associates, LLC
NAME OF PRINCPAL./CUENT:
Collins Hotel Associates, LLC 475 Tenth Ave., 11 floor, NY,NY
BUSINESS NAME AND ADDRESS (Number and Street) (Oty) (State) (Zip Code) 1 001 8
212-277-4184
TELEPHONE NUMBER: FAX NUMBER: (Optional)
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (cn
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
Marc Gordon, Executive Vice President
. ..IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUO!
CORPORATION, PARTNERSHIP OR TRUST:
II. SPEOFIC LOBBY ISSUE: Application for certificate of appropriateness
for property located at 1690 Collins Ave and 1685 James Ave.
Issue to be lobbied (Describe in detail):
m. CITY AGENOES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title B) Any financial, Familial or Professional Relationship
Thomas Mooney none
William Carey none
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLA T RA TE OR OTHER):
$360.00 per hour
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
$360.00 per hour
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
DYes IXNo: Are YOU lobbyina on a oresent or oendina bid for aoods. eauioment or services. or on a
oresent or oendina award for aoods. eauioment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
DYes Xl No: Are YOU lobbylna on a oendina aoolication for a Deyelooment Aareement with the City or
aoolication for chanae of zonina mao desianation or chanae to the City's Future Land Use
Mao?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) 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 clerk as required by this
section but, shall not be required to pay any registration fees..
D Yes.-iXNo: Are YOU reoresentina a not-for-orofit corooration or entity without soecial comoensation
" or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD. ~
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Slgnat re of LobbYist
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting
requirements. ~~
Signature of Lobbyist: _ ~=
Signature of Principal/Client: _ -ll::
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
D Produced 10
GRACE G. CHEN
D Produced 10 N~~Y PUBLIC. STATE OF NEW YORK
Form of Identllca Ion NO.01..cH6056883
4r----lIy known (PrincipaD QUALIFIED IN QUEENS COUNTY 11
~ MY COMMISSION EXPIRES OA-02.20Q.. ,
Form of Identification
JiKPersonally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn flfld subscribed b fore me I
This ~day of 20-..9 b
4~
Signature of Purillc l'IotarY~ State 0
Notarization of Principal's signature
FOR CLERK'S U~c9NL Y
Annual Registration fee: [ Yes [ ] No Amount Paid ~ # 2.Z5i{32....
Lobbyist Registration Form received and verified bY:;:Jo.. ~
F: \CLER\$ALL \MARIA-M\Lobbyist\LOBBYIST fORM 05.
Date Paid ~r:rl OZp
Revised 12/08/04