Michael Larkin/Rosa Martinez
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MIAMIBEACH
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, 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 indudes the principal as well as any employee engaged
in lobbying activities. The tenn "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
Larkin
Michael
W.
NAME OF LOBBYIST:
( Last)
(First)
(M.!)
Bercow & Radell, P.A.
BUSINESS NAME AND ADDRESS
200 South Biscayne Blvd., suite: 850
(Number and Street) (City)
Miami, Florida
(State)
33131
(Zip Code)
(305) 377-6231
TELEPHONE NUMBER:
(305) 377-6222
FAX NUMBER:
mlarkin@brzoninglaw.com
EMAIL:
I. LOBBYIST RETAINED BY:
Rosa Martinez
NAME OF PRINOPAL/CUENT:
845 8200 Street
BUSINESS NAME AND ADDRESS
Miami Beach Florida
(Number and Street) (City)
33141
(State)
(Zip Code)
(305)343-0979
TELEPHONE NUMBER:
FAX NUMBER: (Optional)
rosamartinez@snappydsl.net
EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)J
· NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
· IDENTIFY ALL PERSONS HOLDING, DIRECfL Y OR INDIRECfL Y, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Design Review with regard to Property located at 845 82 Street, Miami Beach, Florida
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Tide
B) Any Financial, Familial or Professional Relationship
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURL Y,
FLAT RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required) -1 3~. per hour
B) PRINOPAl'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).~ 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":
o Yes X No: Are YOU lobbYin9 on a Dresent or oendinG bid for Goods. equipment or services. or on a
pre~nt or oendinG award for goods. equiDment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
uYes X No: Are YOU lobbyinG on a oendinG application for a DeveloDment AGreement with the City or
apDlication for chanGe of zoninG maD desiGnation or chanGe to the City's Future Land Use
MaD?
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..
fJ Yes X No: Are you representin9 a not-for-profit corooration or entity without special comoensation
or reimbursement.
V. SIGNATURE UNDER OATH:
ON OCTOBER 1 Sf OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, USTING 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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Signature of lobbyist
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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. ....... A.4
Signature of Lobbyist: ~~~
Signature of Principal/Client: . / - .:..
VI. LOBBYIST IDENTIFICATION: PRINCIPAL IDENTIFICATION:
Produced ID
Produced ID
Form of Identification
K Personally known (Lobbyist)
VII. NATURE AND STAMP OF NOTARY:
Form of Identification
~(.'''O'<<
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X Personally known (Principal) $..t~~"~~~~ Geysel Ortega
i:tA'}~~COn;missjon #00501265
'::.~~~~i expIres: DEC. 21 2009
;',1. OF f\.",,' ,
-"",,,,\ WW\'1 AARON NOTAR'l
State of Florida, County of Miami-Dade . .com
Sworn and subscribed before me
This ~ yof if! 2ofl0
ignature of Public Notary - S
Notarization of Lobbyist's
/' FOR CL~RK'S USE ONLY
Annual Registration fee: [v) Yes [ ) No Amount paidt..25 eo MCR # )~~G'\b
Lobbyist Registration Form received and verified by: - \~~ Entered By:
F:\CLER\$All\MARIA-M\lolJbyist\L088Y1ST fORM OS.doc l..::.::J
Date Paid
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Revised 12/08/04