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Michael Larkin/North Beach Flats, LLC _ I t1:J ... ,~ , ~~ MI.AMI BEACH 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 includes the principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435. Larkin Michael W. NAME OF LOBBYIST: (Last) (First) (M.!) Bercow & Radell, P.A. Biscayne Blvd., Suite 850 BUSINESS NAME AND ADDRESS (Number and Street) Miami (City) Florida (State) 33131 (Zip Code) (305) 377-6231 TELEPHONE NUMBER: (305) 377-6222 FAX NUMBER: mlarkin@brzoninglaw.com Ef~AIL: I. LOBBYIST RETAINED BY: North Beach Flats, LLC NAME OF PRINCIPAljCUENT: North Beach Flats. LLC BUSINESS NAME AND ADDRESS 321-33 84th Street (Number and Street) Miami Beach (City) Florida (State) 33141 (Zip Code) (305) 828-4070 TELEPHONE NUMBER: (305) 828-9875 FAX NUMBER: (Optional) EMAIL: (Optional) \ Fill out this section If principal is a Corporation, Partnership or Trust [Section 2-482 (c)] \ . NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY: Oscar Delgado . · IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH CORPORATION, PARTNERSHIP OR TRUST: See attached Exhibit A II. SPECIFIC LOBBY ISSUE: Design Review Approval with regard to property located at 321-33 84th Street Miami Beach, Florida Issue to be lobbied (Describe in detail): III. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: A) Full Name of Individual/Title B) Any Financial, Familial or Professional Relationship DRB None 4 < _ .lV. U1:>\.LU:>UKC Ur- ICKM:> AnU AMUUn I:> Ur- LUtJln 1:>1 \.UMI'Cn:>AI1Un lU1:>\.LU:>C wnc 1 nCK nVUKLT, I FLA TJRA TE OR OTHER): " A) LOBBYIST DISCLOSURE: (Required) $320.00 B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). $320.00 ~ L 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": D Yes X No: Are YOU lobbyina on a Dresent or Dendina bid for aoods. eauiDment or services. or on a Dresent or Dendina award for aoods. eauiDment or service? 2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On Real Estate Development Issues": DYes X No: Are YOU lobbyina on a Dendina aDDlication for a DeyeloDment Aareement with the City or aDDlication for chanae of zonina maD desianation or chanae 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.. D Yes X No: Are YOU reDresentina a not-for-Drofit corooration or entity without sDecial comDensation 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. ~~~ 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. ~ I I Signature of Lobbyist: ' , f.b r..-v Signature of Principal/Client:! VI. LOBBYIST IDENTIFICATI PRINCIPAL IDENTIFICATION: ~oduced ID pi I':::::.l 6-1? 3-V3 3 - & y- ~f'y-i> Form of Identification D Produced ID o co .... m co J Personally known (Lobbyist) Form of Identification gnature of Public Notary - State of rid a Notarization of Lobbyist's signature D Personally known (Principal) ~ ".!It. Ana HernandeZ !'~'->f.. My commislion 00195837 '\~I c..........AprlI12.2007 or", ........- . -Dade SIGNATURE AND STAMP OF NOTARY: Annual Registration fee: [' Yes [ ] No Lobbyist Registration Form received and verified by: F:\CLER\$ALl\MARIA-M\LobbyIst\LOBBYIST fORM OS.doc Entered By: r Ii ... EXHIBIT "A" Disclosure of Interest The following is the Disclosure ofInterest for North Beach Flats. LLC. Name of Interest Holder Percenta!!e Interest DELGADO BROTHERS REAL ESTATE DEVELOPMENT, INC. 15476 NW 77 COURT, #705 MIAMI LAKES, FL 33016 POWER ONE REAL EST ATE INVESTMENTS, LLC 7900 NW 155 STREET, #201 MIAMI LAKES, FL 33016 50.00% 50.00% D The following is the Disclosure ofInterest for Del!!ado Brothers Real Estate Development. Inc. JOSE DELGADO 15476 NW 77 COURT, #705 MIAMI LAKES, FL 33016 OSCAR J. DELGADO 15476 NW 77 COURT, #705 MIAMI LAKES, FL 33016 50.00% 50.00% TOTAL 100.00% The following is the Disclosure ofInterest for Power One Real Estate Investments. LLC MICHAEL CAMILLERI 7900 NW 155 STREET, #201 MIAMI LAKES, FL 33016 25.00% LUIS ESPINOSA 7900 NW 155 STREET, #201 MIAMI LAKES, FL 33016 RENE CAMBERT 7900 NW 155 STREET, #201 MIAMI LAKES, FL 33016 REGINALD BEANE 7900 NW 155 STREET, #201 MIAMI LAKES, FL 33016 25.00% 25.00% 25.00% TOTAL 100.00%