Michael Larkin/Brad Meltzerm MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
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 Ordinance 2004-3435.
Larkin Michael W
NAME OF LOBBYIST: (Last) (First) (M.i)
Bercow, Radell & Fernandez P.A. 200 South Biscayne Blvd., suite: 850 Miami, Florida 33131
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(305) 377-6231 (305) 377-6222 mlarkin@brzoninglaw.com
TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
Brad Meltzer
NAME OF PRINCIPAL/CLIENT:
50 North Hibiscus Drive Miami Beach Florida 33137
BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
(786)693-8701 (786) 693-8751 bmeltrer@km-plaza.com
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
out this section if prindpal is a Corporation, Partnership or Trust [Section 2-482
NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
II. SPECIFIC LOBBY ISSUE:
Variance Requests from the Board of Adjustment
Issue to be lobbied (Describe in detail):
III. CITY AGENCIES/INDMDUALS TO BE LOBBIED:
A) Full Name of Individual/Title I B) Any Financial, Familial or Professional Relationship
BOA, DRB
None
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FL,gT~gTEOR OTHER):
A) LOBBYIST DISCLOSURE: (Required) $ 375 00 per hour
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required). 375 00 cer 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":
^ Yes X No Are you lobbvina on a present or cendina bid for goods eouipment or services. or on a
present or pending award for goods eawpment or sernce?
2) Pursuant to Miami Beach City Code 2-490 Entitled 'Prohibited Campaign Contributions By Lobbyists On Real
Estate Development Issues":
^Yes X No Are you lobbvina on a pending application for a Development Agreement with the City or
a hcation for change of zoning map desianatton or d>tanae to the City's Future Land 1~
Ma°?
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 anot-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..
^ Yes X No Are you representing a not for pmt corporation or entity without special oomcensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ 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.
.,/`-~
Si nature of Lo gist
I do solemnly swear that all of the foregoing facts are true and correct and that I have
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and
requirements. /~ _ ~ _ ~
Signature of Lobbyist:
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re of Principal/Client:
LOBBYIST IDENTIFICATION:
Produced ID
Form of Identification
Personally known (Lobbyist)
SIG TORE AND STAMP OF NOTARY:
I County Mi m' ad
bscrib r e
e of Pub otary -State of rids
cation of Lobbyist's signature
read or am
all reporting
tINCIP L IDENTIFICATION:
ced ID
Form of Id ntification
Personally known (Prin 118WNQIi
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State of Florida, County
Sworn and subscribed before me
This day of .7 tr n e , 20 ~' ~
Signature of Public Nota r State of Florida
~- Notarization of Princi 1's signature
FOR CLERK' USE ONLY
Annual Registration fee: ]Yes [ ] No Amount id MCR # Date Paid
Lobbyist Registration Form received and verified by: Entered By.
F:\CLER\$ALL\MARIA-M\Lobbyist\LOBBYIST FORM OS.doc Revised 12/08/04